Complaint Investigation Report

In regard to the allegation” Staff did not answer resident's calls for assistance timely resulting in hospitalization”, It is alleged that staff failed to assist R1’s call for help from the pull cord resulting in R1 having to call 911 for themselves. During interview with Administrator, and staff five (5) out of six (6) stated that R1 pulled his/her pull cord and staff responded by knocking on R1’s door but did not enter room in fear of being yelled at by resident and not until paramedics arriving did, they know that R1 was having an emergency. During interviews with residents six (6) out of six (6) stated that staff may enter their room in case of an emergency with no problem. R1 stated that pull cord was used repeatedly and no staff came to assist resulting in 911 being called.

Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22 and Health and Safety Code. An exit interview was conducted, and a copy of this report was given to Administrator.