Complaint Investigation Report
415601046-12-12-2023-14-AS-KHOS-D26JYE-20240205062746
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
SAN BRUNO RO , 851 TRAEGER AVE., SUITE 360
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/03/2023 and conducted by Evaluator Jaime Vado
COMPLAINT CONTROL NUMBER: 14-AS-20230503083207
- Staff do not provide resident with housekeeping service
- Staff do not safeguard resident's personal belongings
- Staff do not assist resident with grooming
- Staff do not assist resident with showering
- Staff do not provide resident with toiletry item
On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit to investigate further the allegations received and deliver findings. LPA met with administrator Karen Nickolai and explained the purpose of today's visit.
During the course of the investigation LPA conducted interviews, reviewed documents, and made observations of the resident and their room. Resident appeared well kept, groomed, and their room is observed as in order. Toiletry items are provided based on resident evaluations and behaviors. Based on the investigation LPA could not prove or disprove if the allegations took place. These allegations are unsubstantiated.
Based on these observations, the above allegations are UNSUBSTANTIATED.
Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are unsubstantiated at this time.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction