Complaint Investigation Report

565850168-7-1-2022-29-AS-JAPL-CRJV9B-20230505161359

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

06/27/2022 and conducted by Evaluator Teresa Camara

COMPLAINT CONTROL NUMBER: 29-AS-20220627090021

Facility does not have contact information for Ombudsman posted

Licensing Program Analysts (LPAs) Teresa Camara and Elsie Campos conducted an initial complaint visit regarding the above noted allegation. LPAs met with Memory Care Director (MCD) Amber Silverman, LVN and explained the reason for the visit. Executive Director Kim Bergan was out during the visit.

At approximately 09:35 a.m. LPAs met with the MCD, at 10:05 a.m. LPAs interviewed Resident 1 (R1), at 10:29 a.m. LPAs met with Health Services Diretor Sylvia Williams, LVN, at 10:55 a.m. LPAs conducted an interview with a visitor. At approximately 10:15 a.m. LPAs conducted a brief tour of memory care and the main lobby area of the facility. LPAs observed an Ombudsman poster in the assisted living activity room but no poster in memory care where memory care residents can see the poster. Based on observations, the above noted allegation is deemed Substantiated at this time. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D). Exit interview conducted. Report emailed to MCD and Administrator.