Complaint Investigation Report

Based on a review of the forms and documents submitted into CCL by this facility, and its representative, it was learned that a request was made to change the capacity from 4 residents to the ability to accept and retain up to 5 residents at any given time.

It was learned that on 11/26/2024 a request was made from this facility to raise the capacity from 4 to 5 residents with the submission of an LIC 200 and the facility sketch.

It was learned that on 12/09/2024 inquiries were made by this facility to check up on the status of the capacity increase via email.

It was learned that on 12/10/2024 the fire clearance was granted for the capacity increase and the facility Licensee was notified of the approval to be made effective on 12/11/2024 to be able to accept and retain up to 5 residents at any given time.

Based on interviews and a review of additional forms and documents, it was learned that this facility accepted and retained an additional resident from 11/04/2024 to 11/27/2024 which would have meant that this facility was over capacity since there were already 4 residents in care at that time. This facility, at that time, was only licensed to be able to accept and retain 4 residents at any given time but went ahead and accepted a fifth resident.

As a result of this investigation, this LPA found the allegation to be SUBSTANTIATED - A finding that the complaint was Substantiated meant that the allegation was valid because the preponderance of the evidence standard had been met.

The following deficiencies were observed and cited on the following LIC 9099-D pursuant to Title 22 Rules and Regulations, Division 6 and Health and Safety Codes.

A civil penalty of $500 was levied at this time.

Appeal rights were printed and a copy was left with the facility designated representative Blamasee Sarnoa Jr at this time.