Complaint Investigation Report

361880570-10-28-2023-18-AS-KCLS-CXKNYU-20231114095315

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

04/30/2021 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 18-AS-20210430090536

Licensing Program Analysts (LPA) Bernadette Allen arrived at the facility unannounced to deliver the findings for the allegations listed above. LPA met with Administrator Ana Pleitez Stark who left during the visit and gave her care staff Lavonne Brinley approval to sign report.

The investigation consisted of interviews with two (2) staff members who stated that they have not been documenting the MAR for the clients in care.The administrator has also confirmed that accurate documentation has not been conducted per CCL requirements. The interviews also revealed that the licensee has not been conducting any quarterly or annual training for the staff and proof of training could not be provided at the time of the visit.

Based on the evidence gathered during the investigation, the above allegation is found to be Substantiated. A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. A deficiency is being cited on the attached LIC 9099-D.