Complaint Investigation Report

LPA conducted a search of an Unusual Incident Report for (R1) in CCLD's files. LPA did not find any Unusual Incident Report involving R1 for 10/18/23 or around that date. LPA's review of R1's medical record provided by the Investigation Branch (IB) revealed R1 was seen at the Antelope Valley Medical Center for a emergency on 10/18/2023. The discharge instructions revealed R1 had a humeral head fracture ( a break in the upper part of the bone in the upper arm near the shoulder joint) . The discharge instructions state the cause may have been from a fall. Facility was unable to provide LPA with a copy of an Unusual Incident Report for the incident in question. Although the documentation did not reveal R1 struck their head the facility did not document the incident to R1 to CCLD timely. Based on the information reviewed this allegation is deemed Substantiated at this time.

Deficiencies cited (refer to LIC9099-D). Exit interview conducted. Appeal rights explained and copy of this report signed and delivered.