Complaint Investigation Report

392700752-1-20-2022-27-AS-KHOS-CB4P2Y-20220128095643

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

01/18/2022 and conducted by Evaluator Treana White

COMPLAINT CONTROL NUMBER: 27-AS-20220118084554

On 01/20/2022, Licensing Program Analyst (LPA) T. White arrived unannounced to open and investigate the complaint allegation noted above. LPA met with Program Director, Peggy Phelps and explained the purpose of the visit.

During the course of investigation, LPA collected resident roster, staffing roster, and staffing schedule from 01/10/2022 through 01/18/2022. LPA interviewed 4 staff members and 4 clients. Based on client interviews, 4 of 4 clients stated the facility as adequate staffing. Based on staff interviews, 4 of 4 staff stated the facility has sufficient staffing. On 01/18/2022, LPA observed 5 staff present at the facility. On 01/20/2022, LPA observed 9 staff present at the facility. Based on documentation, facility schedule shows the facility is not operating out of ratio. LPA is unable to prove or disprove if allegation occurred.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted with Program Director and a copy of report given.