Complaint Investigation Report

107209035-10-10-2022-24-AS-MHON-CK4T8E-20221011143012

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

09/01/2022 and conducted by Evaluator Mai Yang

COMPLAINT CONTROL NUMBER: 24-AS-20220901110728

Neglect/lack of care and/or supervision resulting in injury to resident

On 10/10/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct complaint investigation visit and deliver complaint finding on the above allegation. LPA introduced self, stated the purpose of the visit, and met with Administrator Rob Huntley.

During the course of the investigation, records reviewed, and interviews were conducted with staff. The facility sought immediate medical attention during the incident of R1’s fall.

It could not be proven or disproven that the facility’s lack of care or neglect of supervisor result in injury to the resident. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is UNSUBSTANTIATED. No deficiencies issued. Exit Interview was conducted. A copy of this report was provided to the Administrator.