Complaint Investigation Report

397003771-6-22-2022-27-AS-KHOS-CFULDZ-20220629084047

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

04/28/2022 and conducted by Evaluator Michael Bilger

COMPLAINT CONTROL NUMBER: 27-AS-20220428133810

On 6-22-22 at 2:20pm, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to deliver complaint findings for the allegation listed above. LPA met with Administrator Mary Margaret Chappell and explained the purpose of the visit. During this investigation, On 6-8-22, LPA interviewed staff1 (S1), S2, and S3. LPA also interviewed Resident2 (R2), R3, and R4. On 6-8-22, LPA also interviewed Administrator on duty at time of alleged incident. Additionally, LPA reviewed facility file documentation including pre-admission appraisal for R1, physician’s report for R1, physician communication note for R1, staffing schedule, and police report dated 4-27-22.

Based on interviews and record reviews conducted, it was determined that Resident1 (R1) stated an allegation of being slapped in the face and punched in the back on 4-27-22 by a caregiver. Interviews conducted and records reviewed revealed no witnesses to said allegation or outstanding visible injuries noted. A police report dated 4-28-22 revealed no visible injuries and no witnesses to alleged incident noted.

As a result, it is determined that there is not a preponderance of evidence to prove this allegation occurred, therefore, this allegation is UNSUBSTANTIATED. An exit interview was conducted with Mary Margaret Chappell and a copy of this report was left with Mary. Appeal rights provided.