Complaint Investigation Report

342700903-10-5-2022-27-AS-KHOS-CLWSVA-20221208131226

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

08/17/2022 and conducted by Evaluator Renee Campbell

COMPLAINT CONTROL NUMBER: 27-AS-20220817141052

Facility Staff are not adequately supervising residents

Facility staff are not ensuring that residents diapers are changed

On 10/05/2022 at 9:45 am, LPA Campbell and LPA Bilger came to facility unannounced to continue a complaint investigation for the allegations noted above. LPA's met with Administrator Justice Ehimamiegho and explained the purpose of the visit. During the course of this investigation, four residents, Administrator and three staff were interviewed as well as a facility observation 08/19/22, 08/31/22 and 10/05/22. LPA's reviewed facility menu and staffing schedule.

Allegation #3 Residents sleep in wet beds and clothes.

Allegation #4 Facility Staff are not adequately supervising residents and

Allegation #5 Staff are not ensuring diapers are changed.

Based on interviews and observations, it was determined that night staff do not consistently change clients overnight and residents clothes and bedding are soaked through by morning. LPA also observed a strong smell of urine during the first investigative visit on 08/31/22. Based on interviews, it was determined residents have to change their diapers overnight if they are able. Due to a preponderance of evidence, this allegation is SUBSTANTIATED.

Allegation 6, Facility is in disrepair. LPA observed bathrooms had no lightbulbs, there was a crack in one of the toilets and the area around the toilet base was chipped and cratered. Paint in the dining area was chipped and had food stains. Due to a preponderance of evidence, this allegation is SUBSTANTIATED.