Complaint Investigation Report

366423935-1-12-2024-56-AS-NBRN-CZRQP3-20240123112000

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

01/08/2024 and conducted by Evaluator Anna Bueno

COMPLAINT CONTROL NUMBER: 56-AS-20240108150621

Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to this facility for the purpose of initiating the investigation of and delivering findings for the above allegations. LPA met with facility staff Christine and Flora Medina-Negado who was advised of the purpose of visit. The investigation consisted of inspection of the physical plant and interviews with relevant parties.

It is alleged that the Facility bedroom door is in disrepair. During the tour of the facility, LPA and staff Christine observed the closed door to room112 with a broken latch. The door is observed with a doorknobu but without a latch.The front part of the door facing the hallway, is missing wood around the lock area, allowing light from inside the room to come through the door. This allegation is therefore substantiated.This poses a potential health and safety risk to residents in care.

A finding that the complaint is SUBSTANTIATED means that the allegations are valid as the preponderance of the evidence standard has been met. Refer to LIC809-D for deficiency cited. A technical violation is issued for physical plant issues discoverd during today's visit. An exit interview was conducted where this report, LIC809-D, and appeal rights were provided to Christine Medina-Negado.