Complaint Investigation Report
It was alleged that Resident #1 (R1) had multiple unstageable pressure injuries due to neglect while residing at the facility. Interviews with staff indicated that R1 had no pressure injuries while residing at the facility. Interview with residents revealed that they are happy with the staff and provides proper care. All of the residents stated that they currently have no issues with neglect and that staff provide proper care and supervision. Based on document reviewed, it was revealed that R1 was admitted to the facility on 7.15.2025. R1 resided at facility until end of July 29, 2025.
Interview conducted by IB investigator revealed R1’s responsible party removed R1 from the facility and moved R1 to an unknown location on 7/29/25. R1 was hospitalized on 8/19/25, when unstageable pressure injuries were discovered. R1’s physician’s report notes no history of skin condition and was not receiving home health services. There were no records indicating that R1 was receiving care for pressure injuries during R1’s stay at the facility.
Therefore, based on interviews and record review and due to lack of supporting evidence, the allegation is unsubstantiated at this time.
No health and safety hazards were noted during the visit.
Exit interview was conducted and a copy of this report was provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction