Complaint Investigation Report
405802134-3-25-2022-29-AS-KBUY-CD7LE9-20220405084111
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CCLD Regional Office , 21731 VENTURA BLVD. #250
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/23/2022 and conducted by Evaluator Rachael De Leon
COMPLAINT CONTROL NUMBER: 29-AS-20220323143945
Staff are not following masking requirements
Licensing Program Anaylst (LPA) De Leon conducted a 10-day Complaint visit to the facility above. LPA met with Administrator Edwin Ingan and explained the purpose of the visit.
LPA Requested a Staff Roster and Resident Roster. Interviewed Staff 1 (S1) and Staff 2 (S2).
On the allegation:Staff are not following masking requirements. LPA interviewed crediable witness (W1) which revealed that W1 visited the facility on 03/16/2022 and upon entry to the facility two staff were present and one staff was sitting at the dining room table with residents and the staff was not wearing a mask. Based on the evidence the allegation is deemed Substantiated at this time.
Exit interview conducted, deficiency cited, copy of report and appeal rights emailed to Licensee/Administrator.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction