Complaint Investigation Report

486803540-6-28-2022-21-AS-KMOA-CFWN4M-20220701100810

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

06/03/2022 and conducted by Evaluator David Leibert

COMPLAINT CONTROL NUMBER: 21-AS-20220603125601

Facility not providing adequate supervision to resident.

Licensing Program Analyst Leibert arrived unannounced for the purpose of delivering findings on this complaint. LPA meet with Renee Dillard and discussed the allegation. During the course of this investigations, site visits were made to the facility, records were obtained, records and regulations were reviewed, and statements taken from witnesses and staff. Based upon the statements and records, the following determinations are made: Facility records for C1 contain contradicting information regarding the level of supervision required for C1 who left the facility on or about March 20, 2022 and trespassed on neighboring property; Physician Assessment (LIC602) for C1 of January 02, 2022 indicates C1 is able to leave the facility unassisted; No theft or damage has been reported and C1 returned to facility after a short absence; Alarm for C1's bedroom window had been turned off in order to open window to air out the bedroom. Although the allegation may be true, based upon the statements and records, the preponderance of evidence standard has not been met. Therefore, the allegation is UNSUBSTANTIATED.