Complaint Investigation Report

547202796-10-18-2021-24-AS-MHON-C8725D-20211026170519

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

10/08/2021 and conducted by Evaluator Lisa Salazar

COMPLAINT CONTROL NUMBER: 24-AS-20211008161810

Staff member used an inappropriate form of punishment on resident in care.

On 10/18/2021, Licensing Program Analyst (LPA) L. Salazar arrived to the facility to conduct the required 10 day site inspection. LPA interviewed licensee and Reporting Party. LPA reviewed Resident R1's Individual Performance Plan (IPP).

Based on the information received, Licensee and reporting party both stated a form of discipline for Resident R1, is to get on the ground and do push ups. Based on the information received, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D. An exit interview was conducted with Licensee Elizabeth Smith. A copy of this report and appeal rights were discussed and provided to Licensee. A plan of correction was developed by licensee and reviewed with LPA.