Complaint Investigation Report

365530014-6-8-2023-56-AS-NBRN-CSSQJX-20230614121327

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

06/02/2023 and conducted by Evaluator Anna Bueno

COMPLAINT CONTROL NUMBER: 56-AS-20230602085022

Staff called the resident inappropriate names.

Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility to initiate the complaint investigation and deliver findings on the above allegation. LPA met with administrator Loraine Kenevan who was informed of the purpose of today’s visit. The investigation consisted of staff and witness interviews and records review.

The allegation is Staff (S1) called the resident (R1) inappropriate names. Interviews with witness confirm that they observed S1 refusing to provide R1 activities of daily living (ADLs). Staff interviews stated that another resident observed S1 talk about R1 and used inappropriate names. Records revealed that S1 was observed and heard S1 call R1 inappropriate names. This complaint is therefore SUBSTANTIATED meaning that the allegation is valid because the preponderance of the evidence standard has been met. This poses a potential risk to the health and safety risk to residents in care.

Refer to LIC809-D for deficiency cited. An exit interview was conducted where this report, LIC809-D, and appeal rights were discussed with and provided to Administrator Kenevan.