Complaint Investigation Report

392700306-5-19-2022-27-AS-LKIG-CEYNCP-20220601102103

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

05/03/2022 and conducted by Evaluator Bruce Jacobs

COMPLAINT CONTROL NUMBER: 27-AS-20220503100420

Lack of adequate staff on the morning shift on May 2, 2022.

Licensing Program Analyst (LPA) Bruce Jacobs arrived at the facility and met with Administrator Gurpreet Rai to deliver investigation findings on the above allegation. This investigation consisted of site inspections to the facility to conduct interviews with the facility administrator, staff and other witnesses.

This investigation concluded that the facility did not have an adequate number of staff on the morning of May 2, 2022. On this day, three caregivers and a Med Tech were scheduled and two caregivers and the med tech called off sick. The Facility Administrator was not able to find replacements for the absent workers until around 11:30 that morning. As a results, the facility was unable to provide the basic service of a scheduled medication administration.

As a result of this investigation, LPA finds the allegations to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies are cited on 9099-D, per Title 22 Regulations, Division 6.

Exit interview conducted and report provided. Appeals rights printed.