Complaint Investigation Report

197609813-11-18-2021-31-AS-CHAS-CECTRV-20220512145810

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

11/12/2021 and conducted by Evaluator Eleza Jackson

COMPLAINT CONTROL NUMBER: 31-AS-20211112081945

Resident(s) in care sustained multiple pressure injuries.

Staff did not meet the incontinence needs of resident(s) in care.

The visit was conducted on Monday, November 15, 2021, but due to a computer err LPA had to return Tuesday, November 12, 2021 for signatures.

Licensing Program Analyst Eleza Jackson conducted an unannounced complaint visit to investigate the allegations above. LPA met with the facility administrator and explained the reason for this visit.

Upon entry to the facility a physical plant tour was conducted at approximately 11:50am to ensure no immediate health and safety issues were present. LPA Jackson did not observe any immediate health and safety issues. LPA Jackson requested the following documents: staff roster, client roster, client daily activities chart, client wound care log, physicians report(s), appraisals for hospice clients. During the initial investigation it was determined that the above-named facility is not the facility in question. Regarding the allegations above a finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. Report reviewed, signed and delivered. Exit interview conducted, no deficiencies cited.