Complaint Investigation Report

019200874-5-3-2024-15-AS-HHUL-D53P7H-20240508110358

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 1515 CLAY STREET, STE. 310

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

02/07/2024 and conducted by Evaluator Jill Clancy-Czuleger

COMPLAINT CONTROL NUMBER: 15-AS-20240207125808

A resident sustained an unexplained injury/fracture while in care.

On 5/3/2024 at 12:30PM, Licensing Program Analysts (LPAs) J. Clancy-Czuleger arrived unannounced to deliver findings for the above allegations. LPA explained the purpose of the visit with Executive Director Stephanie Hall.

On the allegation facility A resident sustained an unexplained injury/fracture while in care. Based on record review and interviews the facility did observe that R1 right shoulder was swollen is leaning to the left side. 911 was called and was sent to the hospital for further evaluation where it was found that Right Proximal Humerus unspecified type fracture. R1 lives on the assisted living floor and the fall was unwitnessed.

Although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted and a copy of this report provided.