Complaint Investigation Report

198603040-10-19-2023-28-AS-RORN-CWWUKA-20231024153849

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

GREATER LA AC/SC , 1000 CORPORATE CNTR DR. ST 500

This is an official report of an unannounced visit/investigation of a complaint received in our office on

04/05/2021 and conducted by Evaluator Christine Wong

COMPLAINT CONTROL NUMBER: 28-AS-20210405152422

Resident received a pressure injury while in care

Licensing Program Analyst (LPA) Christine Wong met with Staff Kevin Qin who allowed the entry for the facility and explained the reason of the visit. A subsequent visit was conducted to issue an additional citation related to allegation “resident received a pressure injury while in care”.

Department review of medical records was completed which revealed systemic failures at the facility in preventing pressure injuries. Immediate $500 civil penalty was issued during today’s visit. At this time an Enhanced Civil Penalty (ECP) determination is pending in reference to Health and Safety Code 1569.49(e) & (f) and may be assessed at a later date. All findings remain the same as indicated on report dated 09/28/23.

Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiency observed during the visit is documented on 809D. Exit interview held and a copy of the report along with appeal rights were provided.