Complaint Investigation Report
392700993-8-21-2023-27-AS-KHOS-CV6LW5-20230829090635
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
08/16/2023 and conducted by Evaluator Michael Bilger
COMPLAINT CONTROL NUMBER: 27-AS-20230816112547
On 8-21-23 at 10:25am, Licensing Program Analysts (LPAs) Michael Bilger and Arvin Villanueva arrived unannounced to open and investigate the complaint allegation noted above. LPAs met with Assistant Executive Director Lucky Kaur and explained the purpose of the visit. During this investigation LPAs interviewed Administrator and resident1 (R1). LPAs also reviewed admission agreement for R1, Physician's report for R1, functional capablities assessment for R1, and discharge paperwork for R1. Based on interviews and record reviews, it was determined that R1 was transported to local emergency department on 8-14-23 after R1 had a discussion with facility staff and signed a notice to discharge. It was further determined that facility accepted resident back to residency on 8-18-23 at approximately 5:30pm and R1 is now currently residing in R1's room.
As a result, the preponderance of evidence standard is not met, and this allegation is UNFOUNDED. An exit interview was conducted with Lucky Kaur and a copy of this report was provided to Lucky.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction