Complaint Investigation Report

577005638-4-29-2022-21-AS-KMOA-CFGUX6-20220617155748

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 1450 NEOTOMAS AVENUE, STE. 100

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

03/17/2022 and conducted by Evaluator Christopher Arnhold

COMPLAINT CONTROL NUMBER: 21-AS-20220317084208

Resident received care without a signed contract.

Facility does not properly document residents’ medication administration.

At approximately 11:30AM, Licensing Program Analyst's (LPAs) Jill Nakagawa and Chris Arnhold arrived at this facility unannounced to deliver findings for the above allegations. LPA's met with Administrator. Based on records reviewed, the allegation that resident did not have a signed contract is unfounded. A signed addmission agreement is on file. LPA's reviewed the medication documents and procedures of the facility. Facility uses pharmacy packaged blister packs that show dates medications are given and pharmacy provides a centrally stored medication list.

This agency has investigated the above allegations. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.