Complaint Investigation Report

157208773-2-9-2023-24-AS-SPIY-CPJLW3-20230302080625

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

11/03/2022 and conducted by Evaluator Katie Brown

COMPLAINT CONTROL NUMBER: 24-AS-20221103095508

Licensing Program Analyst (LPA) Katie Brown arrived unannounced at the facility to conduct a subsequent interview and deliver complaint findings. LPA met with and explained the reason for the visit with Administrator (AD) Ramona Eleco.

During the visit, LPA toured the facility and conducted resident and staff interviews. Resident (R1) was observed sitting in a wheelchair in the dining room waiting for lunch. A padded strap was wrapped around R1 which fastened in the back of the wheelchair. R1 was unable to reach the fastener or release the belt. Additionally, during ths visit, R1 was observed resting in bed with full side rails in raised position.

Based on observation and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. A deficiency is being cited in accordance with California Code of Regulations on the attached LIC 9099-D.

An exit interview was conducted and Plan of Correction was developed. A copy of this report and Appeal Rights were discussed and left with AD, whose signature on this form confirms receipt of these documents.