Complaint Investigation Report

374604148-10-28-2021-08-AS-JRAE-C89U66-20211029151748

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 7575 METROPOLITAN DR. #109

This is an official report of an unannounced visit/investigation of a complaint received in our office on

09/28/2021 and conducted by Evaluator Tiffany Holmes

COMPLAINT CONTROL NUMBER: 08-AS-20210928160959

Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced visit to initiate a complaint investigation regarding the above-mentioned allegation. LPA identified herself, was granted entry, and stated the purpose of the visit to Kyla Hall, Caregiver. During the visit, LPA toured the facility and conducted interviews. LPA observed milk in the refrigerator dated October 2, 2021. The milk did have a distinct smell as though it was old and expiring. Interviews revealed that staff go grocery shopping once a week on Monday's and purchase what they need. The staff that goes grocery shopping buys groceries for all of the houses/facilities. Based on LPA Holmes observation, the above allegation is determined to be substantiated. A substantiated finding means the allegation is valid because the preponderance of the evidence standard has been met. An exit interview was conducted with caregiver Kyla Hall. A copy of this report, the LIC 9099D, and Licensee Appeal Rights (9058 01/16) were emailed to Adminsitrator after the conclusion of the visit, LPA Holmes requested an electronic message reply to confirm receipt of these documents.

This is an amended report from 10/04/2021