Complaint Investigation Report

157206770-4-12-2023-24-AS-MHON-CRJMQ2-20230505094757

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

02/17/2023 and conducted by Evaluator Shawna Doucette

COMPLAINT CONTROL NUMBER: 24-AS-20230217092817

The Department investigated the above allegations and based on interviews and observation, there is not a preponderance of evidence to prove or disprove the allegations occurred therefore the complaint is unsubstantiated. R2's room was toured and no passageway obstructions were observed or reported by R2 or R2's spouse, whom R2 shares a room. R3's room was toured and no pests were observed and pest control records indicate that service was conducted in December 2022, and January and February 2023 in the kitchen, common, and perimeter areas. S1 stated that R4 refuses assistance with showering and will not allow staff in the room. Interview with R4 was unsuccessful in obtaining information regarding this allegation. It was reported and observed that facility reported this concern to the Long-term Care Ombudsman. Based on interviews with the Medication Technician, R5 and R5's responsible party (RP), R5 did not miss any medications when R5's insulin pen broke on 3/2/23. R5's regular pharmacy ordered a replacement pen stat from a local pharmacy until a replacement order could be filled by R5's regular pharmacy.