Complaint Investigation Report

572700714-12-23-2021-21-AS-KMOA-CCLLWY-20220317090753

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 101 GOLF COURSE DR. STE. A-230

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

10/19/2021 and conducted by Evaluator Jill Nakagawa

COMPLAINT CONTROL NUMBER: 21-AS-20211019122728

Paulin Pantig, Administrator (via phone) and Benjie Pulan, Care Staff

Facility did not meet resident's nutritional needs

Licensing Program Analyst (LPA) Jill Nakagawa conducted a complaint investigation regarding the allegation listed above. LPA arrived unannounced on this day for the purpose of delivering findings of the above allegation and met with Benjie Pulan, Care Staff with Paulin Pantig, Administrator (via phone). It is alleged facility is not meeting the resident’s nutritional needs. During the investigation LPA reviewed records, made observations at the facility on 3 separate occasions (10/21/2021, 10/29/2021, 11/03/2021) and conducted interviews and obtained photos.

At today’s inspection, LPA observed that the facility was well-stocked and had a two day supply of perishable foods (including watermelon, pineapple, apaplesauce, juices) and a seven day supply of non-perishable foods as required in regulation Title 22, Division 6, Chapter 8, Article 10, Food Services. LPA observed food stores on several visits on different days of the week, and found supplies were within regulation. Although the allegation may have happened, or is true, there is not a preponderance of evidence to prove the allegation is true or did, or did not, happen. Therefore, the allegation is UNSUBSTANTIATED.