Complaint Investigation Report

197610150-11-16-2021-31-AS-CHAS-CDXVY8-20220429165043

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

11/15/2021 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20211115131106

Staff did not ensure a resident attended dialysis appointments while in care.

Regarding the above allegation, it is alleged that the facility failed to bring R1 to scheduled dialysis appointments.

On 11/16/2021 at 10:30 AM, Licensing Program Analyst (LPA) Nicholas Reed met with Administrator for an unannounced complaint investigation. LPA disclosed the reason for the visit.

At 10:39 AM LPA conducted File Review. Admission Agreement showed R1 admitted on 11/01/2021. LPA also observed a handwritten note which stated "[R1] is refusing to go to Dialysis treatment". The note was signed by the Administrator and R1. At 10:47 AM LPA interviewed R1. LPA asked if R1 wanted to continue dialysis treatments. R1 shook head and replied “No”. To protect R1's personal rights, Administrator does not force R1 to attend dialysis appointments. Based on the information obtained through observation, interview, and records review, the above allegation is false, could not have happened, and/or is without a reasonable basis. Therefore the allegation is deemed unfounded. Exit interview conducted and report emailed to Administrator.