Complaint Investigation Report

197609720-8-5-2022-31-AS-RRAZ-CHF5Z7-20220818202326

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 21731 VENTURA BLVD., STE. 250

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

02/23/2022 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20220223084349

HAVENS AT ANTELOPE VALLEY ASSISTED LIVING, THE

Resident sustained a stage 4 pressure injury while in care

Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced complaint visit & met with Mindy Mendoza. LPA explained the complaint alleged Resident #1 (R1) sustained a stage 4 pressure injury while in care. The complaint investigation was conducted by Investigations Branch (IB) Investigator Jose Santana. The complaint stated R1 developed a stage 4 pressure injury while in care and this resulted from facility neglect. The resident (R1) has been living at the facility since July 26, 2017 and was diagnosed with cellulitis on the buttocks as of August 15, 2017. On April 21, 2020, a home health agency noted a stage 1 pressure injury was located on S1’s sacrum. A diaper rash was noted as of October 15, 2021 on R1’s buttock. The rash was a result of a fungal infection and the redness on the buttock was noted as a stage 1 fungal rash. On February 8, 2022, the home health agency diagnosed the condition as a stage 2 pressure injury on the left buttock and the stage of this pressure injury was confirmed by R’1 physician on February 15, 2022. Based upon the physician’s diagnosis and the home health agency’s notations, the pressure injury progressed to a stage 2 which is not a prohibited condition. The allegation, R1 developed a stage 4 pressure injury while in care is therefore unfounded.