Complaint Investigation Report

107209044-10-7-2021-24-AS-SPIY-C7TUTE-20211015155149

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

11/13/2020 and conducted by Evaluator Mary Garza

COMPLAINT CONTROL NUMBER: 24-AS-20201113103123

Resident sustained an unexplained fall while in care.

On 10/06/2021 Licensing Program Analyst (LPA) M Garza contacted facility Administrator to complete a COVID pre-screening. During conversation Administrator, Jill Stowell informed LPA that they were unavailable currently. Administrator stated to complete visit with Caregiver, Lyn Sta. Maria. LPA arrived at facility and completed a Health and Safety check on resident in care. Residents observed in common area and in rooms.

During the course of the investigation interviews were completed and records were reviewed. Based on the interviews conducted and/or records review the above allegations are UNSUBSTANTIATED. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

Exit interview was conducted with Administrator via telephone. Due to COVID precautionary measures a copy of this report will be email. A delivered and read receipt will serve as confirmation.