Complaint Investigation Report

Allegation: Staff modified the resident’s medical device without authorization

During investigation, the department conducted interviews of residents (R1, R2, R3), facility staff (ADM, S1) & R1’s responsible party (POA) and reviewed resident's(R1) documents. ADM confirmed with LPA that R1's medical device was modified without her authorization to enable them to plug her medical device into the existing 2 prong ungrounded bedroom outlet. LPA observed all residents' bedroom outlets(Rms 1, 2, 3) had two prong ungrounded outlets. LPA observed only the kitchen area had grounded three prong electrical outlets. Based on the department’s observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) that staff modified the resident's medical device without authorization was found to be substantiated.

Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099-D. Failure to submit proof of corrections (POC) by plan of correction due dates and/or any repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted, appeal rights and copy of report provided.