Complaint Investigation Report

496802052-10-6-2022-21-AS-HDBI-CKD2CK-20221019171648

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SANTA ROSA RO , 1450 NEOTOMAS AVENUE, STE. 100

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

09/29/2022 and conducted by Evaluator Victoria Bertozzi

COMPLAINT CONTROL NUMBER: 21-AS-20220929121038

Facility is not following their mitigation plan

Licensing Program Analyst Bertozzi arrived uannaounced to initiate an investigation regarding the above complaint allegation and met with Caregiver, Wilhelfortes Nicdao. Licensee, Luningning (Bot) Alicdan was available by phone and other Licensee, Edwin Alicdan arrived later.

LPA conducted interviews and reviewed files. Per conversation with Licensee, they have had two residents that have tested positive for Covid-19 in the past two months but CCL and the local Department of Public Health were not notified.

The allegation that facility is not following their mitigation plan is Substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.