Complaint Investigation Report

342701084-12-16-2022-27-AS-SRIN-CMJ369-20221227165800

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 2525 NATOMAS PARK DR. STE.270

This is an official report of an unannounced visit/investigation of a complaint received in our office on

12/14/2022 and conducted by Evaluator Victoria Brown

COMPLAINT CONTROL NUMBER: 27-AS-20221214102015

Residents are not being supervised adequately.

Uncleared adult in home aiding resident in home

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on 12/16/22 at 9:00am to investigate the above-mentioned allegations. LPA met with Emily Pascua, Administrator and stated the purpose of the visit. LPA conducted a review of the LIS and Guardian to research if the named person that was left alone with the residents on 12/13/22 were fingerprinted and associated to the facility. Complainant witnessed the unfingerprinted, not associated person working in the facility on 12/13/22. LPA interviewed Emily Pascua, Administrator during this visit. Based on confirmation of the Administrator that this occurred, the above allegation(s) is found to be SUBSTANTIATED. Civil Penalty assessed in the amount of $500.00. (See LIC421IM)

A finding that the complaint allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiencies are being cited on the attached 9099D during this visit. If any of the cited deficiencies are not corrected by the noted due dates; civil penalties may be assessed. The Administrator was provided a copy of their rights (LIC9058) and their signature on this form acknowledges receipt of these rights. An exit interview was conducted and a copy of this report was provided.