Complaint Investigation Report

392700627-12-29-2021-27-AS-KHOS-CACN2N-20220104090502

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 2525 NATOMAS PARK DR. STE.270

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

12/28/2021 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20211228135416

Insufficient food supply for 2-day perishable and 7-day non perishable quantities

On 12-29-21 at 10:05am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to open and investigate the complaint allegation noted above. LPA met with Administrator Jessica Owens and explained the purpose of the visit. LPA conducted facility observation of food storage areas and kitchen areas. LPA also reviewed menu dated 12-26-21 to 1-1-22. Based on observation food supply was adequate to meet the scheduled menu items. Perishable food items include but are not limited to: Milk, eggs, butter. Meat products were observed as well as canned foods and snacks for residents. Food items met the 2-day perishable and 7-day non-perishable food supply during observation. LPA also interviewed Staff1 (S1), S2, and S3, as well as Resident1 (R1), R2, and R3. At 11:50am on 12-29-21, LPA observed lunch meal service and observed all 15 residents eating menu items including vegetables and beverages, as well as snacks. Based on interviews, observations and record review, it is determined that facility is currently meeting the regulatory food supply. Therefore, this allegation is UNSUBSTANTIATED.

An exit interview was conducted with Jessica Owens and a copy of this report was left with Jessica.