Complaint Investigation Report

565800551-3-10-2022-29-AS-KHEN-CCXS4Z-20220328133335

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

10/11/2021 and conducted by Evaluator Joann Rosales

COMPLAINT CONTROL NUMBER: 29-AS-20211011144616

Staff did not notify resident #1 (R1) authorized representative of medical appointments

Licensing Program Analyst (LPA) JoAnn Rosales conducted a subsequent unannounced complaint visit to this facility for the above complaint allegation to deliver final investigation findings. LPA met with staff Ashley Phelps who is authorized to review and sign reports.

Concerns were that staff did not notify R1's authorized representative of medical appointments. Interviews on 3/3/22 starting at 2:07 pm and 3/8/22 at 4:38 pm and a review of R1’s records on 3/10/22 starting at 9:21 am revealed that R1’s authorized representative was not notified of all R1’s medical appointments. Based on the information obtained during the course of the investigation the allegation is deemed substantiated at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 9099-D):

Exit interview conducted. Today's reports and appeal rights were reviewed and emailed to the Administrator.