Complaint Investigation Report

On 02/28/2022, from 2:05 p.m. to 5:15 p.m., Licensing Program Analyst (LPA) Elsie Campos conducted an unannounced initial 10-day complaint visit at the facility regarding the above allegation. At 2:05 p.m., LPA Campos met with Brandy Maynard, Administrator and explained the reason for the visit. During the inspection, the LPA conducted a physical plant tour with the Administrator at 2:08 p.m. and conducted a record review beginning at 2:30 p.m. There were three (3) staff and four (4) residents present. The LPA reviewed records for four (4) residents and obtained pertinent copies. The Administrator was notified that the complaint was referred to the Community Care Licensing Investigations Branch (IB) and assigned to Investigator Lorraine Patterson.

On 03/11/2022, at approximately 1:13 p.m., Investigator Patterson conducted interviews with the reporting party; on 06/21/2022, from approximately 11:19 a.m. to 11:40 a.m., with C1 and facility staff; on 06/27/2022, from approximately 10:30 a.m. to 2:11 p.m., with C1’s conservator/representative and Administrator; and on 06/28/2022, at approximately 11:11 a.m., with facility staff. Additionally, Investigator Patterson reviewed C1’s facility file documents, incident reports, photographs, and UCLA Health System medical records.

According to the Physician Report, dated 09/27/2021, C1’s diagnoses includes Schizophrenia, Mild Intellectual Disabilities, Psychosis, Seizure Disorder, Insomnia and Leukodystrophy. C1 is non-ambulatory, uses wheelchair, and requires assistance with activities of daily living (ADLs). C1 also has behaviors due to neurological issues which include verbal and physical aggression, property destruction and self-injurious (SIB) behavior.

On 02/22/2022, the Administrator submitted a Special Incident Report (SIR) listing the incident date involving C1 as 02/14/2022 at 5:45 a.m. The Administrator reported that on 02/15/2022, C1’s conservator/representative contacted the facility and reported that C1 had a bruise on C1’s nose. C1’s conservator/representative observed C1 with a bruised, purple and puffy nose. On 02/15/2022, during C1’s routine doctor appointment, C1’s conservator/representative asked that all C1’s extremities be examined. An X-ray was taken of the nasal bone and the Dr. confirmed that C1 sustained a minimally displaced fracture of the nasal bone. The Administrator followed up with facility staff #1 (S1) who reported that during a routine transfer C1 rolled and fell face forward from bed onto a fall/injury prevention mat next to C1’s bed.