Complaint Investigation Report

565801682-2-1-2023-29-AS-JAPL-CNMVUV-20230201154518

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

01/30/2023 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 29-AS-20230130093413

Resident sustained unexplained injuries while in care.

Staff refused to accept resident back to the facility after a hospital visit.

Staff are not responding to requests for communication about resident in a timely manner.

Licensing Program Analyst (LPA) Ashley Smith arrived unannounced to conduct a subsequent complaint visit. The LPA met with Administrator Cilva Toume and explained the reason for the visit. To investigate, the LPA interviewed staff on 01/30/2023 at 1:44 p.m. and 1:55 p.m. The LPA spoke with a family member of Resident #1 (R1) on 01/30/2023 at 1:07 p.m. and on 1/31/2023 at 3:12 p.m. The LPA also interviewed a staff person at a collateral facility at 1/31/2023 at 1:25 p.m. and, the LPA obtained relevant records.

The allegations above pertain to Resident #1 (R1). The investigation revealed that R1 did not reside at this facility and resided at a congregate living facility, which is licensed by the California Department of Public Health. Per the investigation, the allegations are deemed Unfounded at this time. A finding of Unfounded means that the allegations are either false, could not have happened, and/or is without a reasonable basis.

No deficiencies cited at this time. Exit interview. A copy of the report was issued.