Complaint Investigation Report

342700140-8-28-2023-27-AS-KHOS-CV6MKY-20230829094132

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

08/25/2023 and conducted by Evaluator Victoria Brown

COMPLAINT CONTROL NUMBER: 27-AS-20230825095012

Staff did not seek medical attention to resident in care.

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced to investigate the above mentioned allegation on 8/28/23 at 9:30am. LPA met with Antonette Tin and stated the purpose of the visit. LPA conducted interviews during this visit of staff and resident #1 (R1). Regarding allegation, "Staff did not seek medical attention to resident in care." LPA conducted interviews which revealed that Administrator Antonette Tin did not seek medical attention upon the request of R1's Licensed Skilled Professional. Administrator stated that she was reiterating how a lack of medication could affect R1's behavior based on R1's past history and responsible party information. Based on interviews and the admittance from the Administrator that she did not seek medical attention for R1 because R1 was not having behaviors. The preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Per California Code of Regulations (CCRs) - Title 22, Div.6, Ch. 8, deficiencies are being cited on the attached 9099D during this visit. If any deficiencies are not corrected by the noted due dates; civil penalties may be assessed. A copy of their rights was provided (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.