Complaint Investigation Report

455002494-8-15-2022-25-AS-MSEY-CHEM7F-20220818092124

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 520 COHASSET RD., STE. 170

This is an official report of an unannounced visit/investigation of a complaint received in our office on

05/04/2022 and conducted by Evaluator Shannon Diegoruelas

COMPLAINT CONTROL NUMBER: 25-AS-20220504102120

On 8/15/2022 Licensing Program Analyst (LPA) Shannon Diegoruelas arrived at the facility unannounced and met with Mikko Ammon to deliver complaint findings regarding the allegation that staff hit resident with object. Prior to visit LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; contacted facility staff and completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn; surgical Mask. Additionally, LPA was screened by facility staff at the front door.

During the course of the investigation, LPA conducted interviews with residents and staff. Interview with resident R1 indicated that they were hit by staff with a pine sol bottle. During the same interview, R1 indicated that they were hit with a water bottle instead of a pine sol bottle. R1 was interviewed on another date and indicated that staff were nice and respectful. Interviews revealed conflicting information. Interview with resident R2 indicated that they have not witnessed any staff hit R1. Interviews with staff S2, S3, and S7 indicated that they have not witnessed any staff members hit any residents in care. Interview with S6 also indicated that R1 has been known to make false statements.

Based on interviews conducted, LPA finds the allegation to be UNSUBSTANTIATED, a finding that the complaint is Unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

No deficiencies were cited during today's visit. Exit interview was conducted and a copy of the report was provided to Administrator.