Complaint Investigation Report

• Physician’s Reports dated: 7/13/20 and 3/22/22 • Preplacement Appraisal Information • Identification and Emergency Information • Consent for Emergency Medical Treatment • Release of Client/Resident Medical Information • Admission Agreement • Resident Roster • Personnel Report

The investigation revealed the following;

Allegation: Resident missed scheduled optometrist appointments while in care.

Based on interviews conducted, there were multiple statements obtained which were consistent and corroborated with the above-mentioned allegation. R1 had an appointment scheduled with an Optometrist sometime in October or November of 2021 (exact date unknown) and R1 ended up missing her appointment due to facility not providing transportation and failing to make arrangements for R1 to see her Optometrist. LPA discovered that there was no driver on the day of the appointment. Based on the investigation conducted, there was sufficient evidence found, proving the above-mentioned allegation to be true.

Allegation: Staff did not address a resident's change in medical condition.

R1 was admitted to Burbank Retirement Villa East (BRVE) on 7/17/2020. While reviewing the file for R1, LPA discovered that R1 had concerns related to her vision (Right Eye), prior to her admission at BRVE. On the summary report from Emerald Terrace Convalescent Hospital (ETCH), dated 6/26/202, it states “follow up with Ophthalmology due to Right Eye blindness”. While reviewing the Preplacement Appraisal for R1, facility staff documented R1’s vision as “good” and there was no indication regarding vision concerns involving R1. On the physician’s reports dated 7/13/20 and 3/22/22, R1 was listed as not having a visual impairment. During R1’s stay at BRVE, R1 had several appointments with the Optometrist due to decline/change in her vision, yet facility staff failed to update the changes in her medical condition and keeping the appraisal accurate. Based on interviews conducted and record reviews, there was sufficient evidence found, proving the above-mentioned allegation to be true.

Based on LPA’s observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be Substantiated. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D.

An exit interview was conducted and a copy of this report was provided along with the Appeals Rights.