Complaint Investigation Report

107202659-3-14-2023-24-AS-SPIY-CQ7KKH-20230323075821

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

03/08/2023 and conducted by Evaluator Les Xiong

COMPLAINT CONTROL NUMBER: 24-AS-20230308164502

Resident sustained unexplained injury while in care.

Licensing Program Analyst (LPA) L. Xiong conducted the complaint investigation visit to the facility. I met with administrator, Sundari Kendakur and informed her the purpose of the visit.

During the course of this investigation LPA reviewed facility files and interview R1 and staff relevant to the complaint investigation. It was determined that the above allegation: Resident sustained unexplained injury while in care is UNFOUNDED. The evidence from the investigation indicated R1 had an unwitnessed fall as reported by the facility. This agency has investigated the complaint alleging (Resident sustained unexplained injury while in care). We have found that the complaint was unfounded, therefore we have dismissed the complaint.