Complaint Investigation Report

Allegation #1: Staff did not have documentation of resident's medical history to responding emergency medical personnel.

The complaint alleges that the staff did not have documentation of Resident #1's (R1) medical history for the responding emergency medical personnel. Reports indicate attempts were made to obtain paperwork and communicate with the care facility staff regarding the (R1's) condition. However, the staff had no paperwork and did not provide any information about (R1's) health condition or mental status. No additional information was provided.

According to the Identification and Emergency Information (LIC 601) dated May 1, 2023, and the Admission Agreement and Contract dated April 24, 2025, (R1) was admitted to Prim Villa Cloud on May 1, 2025. (R1) began receiving home health services from Oak Tree Home Health, Inc. on September 28, 2025. On November 28, 2025, (R1) was hospitalized at Long Beach Memorial Hospital due to general weakness and labored breathing.

On December 5, 2025, between 10:00 AM and 11:10 AM, the Department interviewed staff members identified as Staff #1 through Staff #3 (S1-S3). Three (3) out of the three (3) could not support this claim. (S1 and S2), who were present when emergency medical personnel were dispatched on November 28, 2025, stated that (R1’s) medical documentation was available for the emergency medical services (EMS). (S1) indicated that (EMS) was provided with (R1’s) service binder, which contained the Medical Assessment for Residential Care Facilities (LIC 602A), the Appraisal/Needs and Services Plan (LIC 625), and the Physician Orders for Life-Sustaining Treatment. However, (EMS) only requested copies of the Identification and Emergency Information form (LIC 601) dated May 1, 2025, and the Medication Record dated October 1, 2025. (S1 and S2) verbally shared (R1's) primary medical diagnoses with (EMS). Upon being informed of (R1’s) condition, (S3) promptly reached out to (R1’s) home health provider and family representative without delay. (S3) emphasized the urgency of the situation by instructing the facility to contact 911 for immediate emergency assistance.

On December 05, 2025, between 10:50 AM and 11:30 AM, the Department interviewed resident members identified as Resident #2 and Resident #3 (R2 and R3).