Complaint Investigation Report

455002676-10-8-2021-25-AS-KHOS-C8LS2P-20211109122953

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

10/06/2021 and conducted by Evaluator Misty Valencia

COMPLAINT CONTROL NUMBER: 25-AS-20211006140417

Lack & Care Of Supervision-Falls due to medication error

Personal Rights-resident with long and dirty fingernails

On 10/05//2021, Licensing Program Analyst (LPA) Misty Valencia conducted an unannounced complaint investigation visit regarding the above allegations directed by the department. LPA met with Facility Manager Audra Enieix and explained the reason for the visit. Prior to initiating the 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 Administrator 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 masks. Additionally, LPA was screened by staff at the front door.

During interview with Administrator, who reported that there are no residents by R1's name that reside a tthe fa ility. LPA finds allegation to be UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview conducted and a copy of report was emailed to Lincensee