Complaint Investigation Report

361880853-6-23-2022-56-AS-KCLS-CKTS9T-20221103134115

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

06/17/2022 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 56-AS-20220617124956

Facility did not properly appraise resident

Resident’s medical documents were falsified.

Licensing Program Bernadette Allen conducted an unannounced visit to the facility to commence a complaint investigation. LPA Allen was granted entrance by acting administrato Kara Richardson. At 12:45 PM the director Niaz Khalid arrived LPA Allen identified herself and discussed the elements of the visit regarding the above allegations.

The allegation #1 states that the facility did not properly appraise residents and allegation #2 medical documents were falsified. LPA interviewed (3) staff members (3) residents and reviewed (6) six residents files all of which were confirmed that files are in compliance. LPA identified physicians’ orders and records which were also in compliance.LPA was unable to corroborate the above allegations.LPA has determined that the allegations above are Unsubstantiated.

A finding that the complaints is UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time.

No deficiencies were cited during this visit. An exit interview was conducted where this report was discussed with and a copy was provided to the Director Niaz Khalid.