Complaint Investigation Report

567609938-3-29-2023-29-AS-DPEA-CQF4AY-20230330185640

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

11/16/2022 and conducted by Evaluator Zabel Chochian

COMPLAINT CONTROL NUMBER: 29-AS-20221116082417

Staff is not providing Ombudsman Representative with resident's records upon request.

Licensing Program Analyst (LPA) Zabel Chochian conducted a subsequent complaint visit to this facility today regarding above allegation. Upon arrival LPA met with staff and Administrator was contacted. Reason for visit was explained and allegation finding was discussed with Administrator by telephone.

Following is a summary of the investigation:

On 11/22/2022, a complaint visit was initiated and between 2:30pm-2:45pm, Resident (R1) records was reviewed and copies obtained. Between 2:45pm-3:15pm, LPA conducted interview with R1.

On 01/30/2023, potential witness who is a reliable source was interviewed approximately 1pm. Information was provided that the Administrator did not provide R1's records when requested to assist R1 with a specific request. Administrator reported that R1's file was eventually provided however she was not certain about whether or not she can provide copy of the power of attorney records.

Based on the information gathered, the allegation is deemed Substantiated at this time.

Pursuant to Title 22, California Code of Regulations, the deficiency will be cited on 9099-D.

Exit interview conducted, deficiency cited, copy of this report and appeal rights provide.