Complaint Investigation Report

361800147-5-6-2022-18-AS-NBRN-CESN9M-20220526101608

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

01/05/2022 and conducted by Evaluator Anna Bueno

COMPLAINT CONTROL NUMBER: 18-AS-20220105101235

Staff is not assisting resident with hygiene needs.

Facility is not safeguarding resident's belongings.

Staff are not ensuring resident has clean clothes.

Resident's room does not have adequate lighting.

Resident's bed does not have appropriate linens.

Facility not notifying responsible party about incidents.

Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility to deliver findings on the above allegations. LPA met with Mikaila Tonan, receptionist. The investigation consisted of file review, interviews with relevant parties, and observations of the facility.

Allegation 1: Staff is not assisting resident with hygiene needs. Interviews reveal that Resident 1 (R1) is ambulatory and capable of self-care with minimal assistance. Allegation 2: Facility is not safeguarding resident's belongings. Based on observations and interviews, LPA was able to confirm that it is the facility’s policy to have residents label their belongings. Allegation 3: Staff are not ensuring resident has clean clothes. Interviews reveal that R1 always has clean clothes available however R1 may need to change clothes after meals. Allegation 4: Resident's room does not have adequate lighting. LPA was unable to find corroborating evidence relating to this allegation. Allegation 5: Resident's bed does not have appropriate linens. LPA was able to verify that the facility has a supply of clean linen labeled with the facility’s name and residents are also able to use their own linens. Allegation 6: Facility not notifying responsible party about incidents. File reviews and interviews revealed that responsible parties were notified of incidents involving R1.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED at this time. An exit interview was conducted where this report was discussed and provided to Mrs.Tonan.