Complaint Investigation Report

347005162-9-21-2021-27-AS-SRIN-C73Q29-20210921114646

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

09/03/2021 and conducted by Evaluator Victoria Brown

COMPLAINT CONTROL NUMBER: 27-AS-20210903091307

Facility has no supervision during evening hours

Facility has no staff to assist with medications

THIS REPORT IS AMENDED TO COMPLETE THE 9099 APPROPRIATELY RATHER THAN VAGUELY. LICENSEE AGREED.

THIS REPORT IS TO DELIVER THE FINDINGS OF UNFOUNDED. During the investigation, it was discovered that the resident did not reside in this home at this facility number. Therefore the findings are deemed UNFOUNDED.