Complaint Investigation Report

547206666-10-15-2021-24-AS-MHON-C88KPL-20211028080453

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

09/30/2021 and conducted by Evaluator Mai Yang

COMPLAINT CONTROL NUMBER: 24-AS-20210930110028

Staff are not isolating COVID (+) residents.

During the course of the investigation, LPAs Mai Yang and David Ayers conducted virtual tour of the facility due to facility having clients who were COVID-19 positive at the time. LPA’s observed that facility was not following COVID-19 health and safety precautions when they were allowing 3 of 4 COVID positive clients to cohort with 1 of 4 COVID-19 negative clients. In addition, staff were not wearing surgical masks.

Based on LPAs observation, the preponderance of evidence standard has been met therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 1, Article 6, Section 80072(a)(2) is being cited on the attached LIC9099D. Appeal rights provided and exit interview conducted.