Complaint Investigation Report

486803359-11-16-2021-21-AS-CMAZ-C8WRKG-20211119120530

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 101 GOLF COURSE DR. STE. A-230

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

10/14/2021 and conducted by Evaluator David Leibert

COMPLAINT CONTROL NUMBER: 21-AS-20211014093428

Resident sustained injuries while in care

Licensing Program Analyst Leibert arrived unannounced for the purpose of delivering findings on this complaint. LPA met with Alma Cupid to discussed the findings. During the course of this investigation statements were taken from witnesses and staff; records were obtained and reviewed; site visits made to facility and collateral program. The following determinations are made: C1 sustained several scratches on body while at the facility; Staff have not provided an explanation for the origin of the injuries; C1 has stated to witnesses that the scratches were self inflicted. There are differing opinions regarding the cleanliness clothing of C1; Case Manager for C1 reports that C1's clothing was not found to be dirty during the course of unannounced quarterly visits to the facility. Although the allegations may be true or valid, based on records and statements, the preponderance of evidence standard has not been met. Therefore, the allegations are UNSUBSTANTIATED.