Complaint Investigation Report

360908446-4-8-2022-18-AS-KCLS-CE43LW-20220503182121

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 1650 SPRUCE ST STE 200 MS29-27

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

01/13/2022 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 18-AS-20220113091353

Facility did not provide resident personal records per resident's request.

Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to the facility to deliver findings on the above allegation. LPA met Cecile Yan- Administrator

LPA interviewed the licensee and the Administrator about the above allegation. The licensee and administrator both acknowledged receiving the request for Client records from an outside party. They also acknowledged that the records were not provide within a reasonable time frame. Although the documents were eventually sent to the requester, it was not provided in a timely manner per Title 22, Division 6 of the California Code of Regulations.

Based on interviews conducted and documents reviewed the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, (Title 22, Division 6 & Chapter 1) is being cited on the attached LIC9099D.

An exit interview was conducted where this report, LIC9099D, and appeal rights were discussed and provided to Cecile Yan- Administrator .