Complaint Investigation Report

342700525-8-19-2022-25-AS-APEZ-CHVMJP-20220902093927

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 520 COHASSET RD., STE. 170

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

03/30/2022 and conducted by Evaluator Jacob Williams

COMPLAINT CONTROL NUMBER: 25-AS-20220330143305

Licensing Program Analyst (LPA) Williams arrived at the facility unannounced on 08/19/2022 to deliver complaint findings for the allegation listed above, LPA met with Stephen Macdonald, Executive Director, and explained the purpose of the visit. Prior to initiating visit LPA completed daily self-screening questionnaire to confirm no symptoms of COVID-19 and wore surgical mask.

Through document review and staff interviews, it is determined that although facility may have generated SIR in house, it was never delivered to CCL, as required by regulations.

The department finds the allegation to be SUBSTANTIATED, a finding that the complaint is Substantiated means that the allegations are valid because the preponderance of the evidence standard has been met.

Exit interview conducted, appeal rights provided, and copy of report provided to facility.