Complaint Investigation Report

015601083-2-2-2023-15-AS-HHUL-CR3M38-20230420091442

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

10/27/2021 and conducted by Evaluator Grace Luk

COMPLAINT CONTROL NUMBER: 15-AS-20211027131341

Staff are not monitoring a resident's blood glucose levels while in care

On 2/2/2023 at 11:00AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a complaint investigation and deliver findings in regards to the allegation above. LPA met with Care Coordinator, Bessy John and informed her the reason for the visit.

During the course of investigation, LPA interviewed residents and staff. Resident's physician's report, care plan, care notes, blood sugar log, and doctor's order were obtained and reviewed. LPA observed R1's blood sugar log in October 2021 states that blood sugar should be checked 2 times a day. However, R1's blood sugar log was missing information and majority of the month only had blood sugar checked once.

Based on LPA's information obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, are being cited on the attached LIC9099D. Exit interview conducted. A copy of this report and appeal rights provided.