Complaint Investigation Report

547203448-1-25-2023-24-AS-MHON-CQ6T2F-20230322142037

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

11/14/2022 and conducted by Evaluator Malia Thao

COMPLAINT CONTROL NUMBER: 24-AS-20221114142745

Facility staff confined resident to their room.

On 1/25/23 at 1:45 PM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct a complaint investigation. LPA explained reason for inspection and was granted entry by Licensee/Administrator (LIC) Davilyn Mancilla.

LPA interviewed LIC. During the investigation, LPA reviewed records and conducted interviews. LPA found that facility staff confined resident to their room. LIC stated a plastic door knob cover was placed on the inside door knob of R1's bedroom to prevent R1 from leaving the facility after R1 AWOL'd the second time from the facility. Therefore, the above allegation is substantiated.

A deficiency is being cited based on LPA interviews conducted and record review in accordance with the California Code of Regulations, Title 22, see LIC9099D. Exit interview conducted and a Plan of Correction was developed with Licensee. A copy of this report and appeal rights were given to Licensee, whose signature confirms receipt of this report.