Complaint Investigation Report

565850108-2-10-2023-29-AS-DPEA-CP5SZ3-20230217131829

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 21731 VENTURA BLVD. #250

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

02/09/2023 and conducted by Evaluator Kelly Dulek

COMPLAINT CONTROL NUMBER: 29-AS-20230209112701

Staff neglect caused a resident to be hospitalized while in care

Licensing Program Analyst (LPA) Kelly Dulek conducted an initial complaint investigation for the allegation listed above. LPA arrived at the facility at 11:51 AM and met with facility designee Flordeliza Hipolito, who is authorized to sign reports. Entrance interview conducted.

During today's visit, LPA interviewed facilty designee and obtained a copy of the facility's resident roster. Interview and review of roster revealed that Resident #1, whom the complaint is in reference to, does not reside at this facility. Based on the information obtained, the allegation is deemed UNFOUNDED at this time. A finding of unfounded means that the allegation is either false, could not have happened, and/or is without a reasonable basis.

Exit interview conducted. A copy of the report was provided.