Complaint Investigation Report

On 05/26/2020, between 2:45 p.m. and 3:15 p.m., LPA Richardson conducted the initial complaint visit. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, the complaint investigation was conducted telephonically. At 2:45 p.m., the LPA conducted an interview and physical plant tour via video call with facility administrator Serguei Kalistratov. At 3:00 p.m., the LPA requested copies of pertinent documents relevant to the investigation and noted further investigation would be required.

On 05/26/2020, LPA Richardson ordered the following records:

- home health records from R1’s Home Health Agency

- medical records from the hospital for R1’s admission on 05/14/2020

- medical records from the Medical Center for R1’s admission on 5/20/2020

On 10/17/2020, LPA Richardson conducted telephonic interviews with the administrator at 10:00 a.m. and R1’s responsible party (RP) at 1:00 p.m. The RP indicated R1 was originally admitted to the facility with wounds and received wound care from the home health agency. The RP had concerns about facility staff not repositioning R1 frequently enough or providing incontinence care at night because the night shift staff slept at the facility. The RP stated that after R1’s stay at the hospital on 05/14/2020 through 05/18/2020, R1 returned to the facility in worse condition. The RP stated R1 was admitted to the Medical Center for further care on 05/20/2020. The RP was aware R1 had developed more pressure injuries but could not say if they developed at one of the hospitals or the facility. The administrator stated R1 was released from the Medical Center on 05/26/2020 on hospice and R1 passed away on 06/04/2020.

During LPA Camara’s visit to the facility on 03/15/2022 between 12:15 p.m. and 1:27 p.m., LPA Camara interviewed a visitor at the facility at 12:17 p.m., conducted a brief plant tour at 12:26 p.m., and interviewed the administrator at 12:45 p.m. The administrator stated he was the primary caregiver for R1; he ensured he and the staff kept R1 clean and repositioned as per the home health nurse directions. Due to the age of R1’s records, they were no longer stored at the facility. The administrator was asked to bring R1’s records, including hospice records, to the Community Care Licensing (CCL) office in Woodland Hills the following day. On 03/16/2022, the administrator came to the CCL office with R1’s records, however the administrator did not