Complaint Investigation Report

392700306-6-24-2022-27-AS-KHOS-CFUHUC-20220629063007

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

05/24/2022 and conducted by Evaluator Bruce Jacobs

COMPLAINT CONTROL NUMBER: 27-AS-20220524125408

Facility had inadequate staff on the morning of May 22,2022

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 22, 2022. On this day, two caregivers and a Med Tech were scheduled and one caregivers and the med tech called off sick. The Facility Administrator was not able to find replacements for the absent workers until around 10:30 that morning leaving only one caregiver for the facility until that time.. As a result, 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.