Complaint Investigation Report

374603451-8-2-2022-18-AS-DMUN-CHFV68-20220819160906

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

07/25/2022 and conducted by Evaluator Tricia Danielson

COMPLAINT CONTROL NUMBER: 18-AS-20220725094743

Staff refused to accept resident back into the facility

Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to initiate an investigation into the allegation listed above. LPA met with Executive Director (ED) Amy Banaga and explained the purpose of the visit.

During today's visit, LPA interviewed ED Banaga and discussed the events surrounding Resident #1 (R1) and their recent hospitalization. Regarding the allegation "Staff refused to accept resident back into the facility", it was alleged that R1 was not permitted to return to the facility upon their discharge from the hospital on July 21, 2022 due to safety reasons. Interview with ED Banaga revealed she had received a phone call from R1's hospice agency to discuss R1's return to the facility and did inform the hospice agency that the facility would not accept R1 back due to the safety risk involved in accepting R1 back. Based on LPA interview which was conducted, the preponderance of evidence standard has been met, therefore the allegation "Staff refused to accept resident back into the facility" is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 is being cited on the attached LIC 9099D. An exit interview as conducted with ED Banaga and a copy of this report was provided along with Appeal Rights and LIC811- Confidential Names List.