Complaint Investigation Report

107206911-1-5-2023-24-AS-SMOA-CMSVQU-20230105153852

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

10/10/2022 and conducted by Evaluator Mai Yang

COMPLAINT CONTROL NUMBER: 24-AS-20221010082850

Administrator Katherine "Katie" Chattom via telephone and Licensed Vocation Nurse Kimberly Pendergraft,

Residents sustained injuries while in care.

Staff did not schedule resident's medical appointments in a timely manner.

On 01/04/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to deliver complaint findings on the above allegations. LPA introduced self, stated the purpose of the visit, and met with Kimberly Pendergraft, Licensed Vocational Nurse (LVN) Administrator Katherine “Katie” Chattom and Program Director Misty Bryson was called and unable to attend meeting. Administrator authorized LVN to received and signed report. LPA spoke with Administrator via telephone and delivered complaint findings.

During the course of the investigation record were reviewed and interviews were conducted. C1 and C2 sustained injuries while in care. Staff unaware how client’s sustained injuries. C1 and C2 was scheduled for medical appointment after Regional Center observed client’s with injuries.

Based on record reviewed and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Under California Code of Regulations, Title 22, are being cited on the attached LIC 9099D. Plan of correction was discussed. An exit interview was conducted, and a copy of this report and appeal rights was provided to via email to Administrator.