Complaint Investigation Report

486803653-7-26-2022-21-AS-HDBI-CGVN5U-20220801101003

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 1450 NEOTOMAS AVENUE, STE. 100

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

06/21/2022 and conducted by Evaluator Farhaan Sarangi

COMPLAINT CONTROL NUMBER: 21-AS-20220621155627

Resident's room is not maintained clean and sanitary.

Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at Rockville Terrace Senior Living for the purpose of delivering complaint findings on a complaint that was initiated on June 30, 2022. LPA was greeted at the door by Administrator, Mikayla Muehleisen, and was granted access into the facility.

Complaint alleges that resident's room is not maintained clean and sanitary. During the course of the investigation, LPA toured the facility with the Administrator on July 26, 2022, July 14, 2022 and June 30, 2022. While opening the complaint on June 30, 2022, and during a tour of the facility with the Administrator on this date, LPA observed R1's room having a very strong odor of urine. Furthremore, LPA conducted interviews with a staff member and learned that R1's room was not sanitary.

The following deficiencies were observed (see LIC 9099D) and cited from the California Code of Regulations, Title 22, Division 6, Chapter 8 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and a copy of this report along with appeal rights were emailed to the Administrator due to printer issues.