Complaint Investigation Report

019200509-5-4-2023-15-AS-YFLS-CRVRL9-20230516130647

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

02/24/2023 and conducted by Evaluator Luisa Fontanilla

COMPLAINT CONTROL NUMBER: 15-AS-20230224095354

Resident developed an open sore while in care

On this day at approximately 2pm , Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to deliver findings on the above allegation and met with Robert Roby and explained the purpose of the visit.

During the course of investigation, LPA obtained records and interviewed staff on 3/22/2023. On April 4, 2023, LPA interviewed Home Health Nurse who provided wound treatment to Resident 1 (R1).

Based on records review and interviews conducted, R1 developed Stage 2 pressure injuries on left posterior thigh and Stage 1 pressure injury on coccyx. A home health agency was contacted to provide wound treatment to R1.

Based on information obtained, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations Title 22 is being cited on the attached Lic 9099D.