Complaint Investigation Report

107206952-8-10-2022-24-AS-SMOA-CHEUHF-20220818153553

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

11/01/2021 and conducted by Evaluator Mary Garza

COMPLAINT CONTROL NUMBER: 24-AS-20211101082313

Staff left resident in a wheelchair that was positioned in an unsafe manner

On 8/10/2022 Licensing Program Analyst (LPA) M. Garza arrived at facility to complete an unannounced complaint visit to deliver findings. LPA was COVID pre-screened at time of entry. Administrator was contacted and reason for visit was discussed. LPA completed a health and safety check on residents in care. Residents observed in common areas and in rooms.

During investigation, LPA completed interviews with RP, staff and residents. LPA reviewed 4 of 4 staff files located at the facility. 4 of 4 files were not complete. LPA observed photo of R3 in an unsafe position in their wheelchair. Wheelchair was observed to be leaning on a chair with the front wheels of the wheelchair in the air. The allegations listed above are found to be SUBSTANTIATED based on LPA’s record reviews and observations. Per Title 22, deficiencies cited on LIC9099-D.

Exit interview completed. Appeal rights and a copy of this report given.