Complaint Investigation Report

216804022-3-21-2023-21-AS-CMAZ-CQ8VMX-20230324163415

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 1450 NEOTOMAS AVENUE, STE. 100

This is an official report of an unannounced visit/investigation of a complaint received in our office on

11/16/2022 and conducted by Evaluator David Leibert

COMPLAINT CONTROL NUMBER: 21-AS-20221116141751

Resident sustained an injury due to lack of care and supervision

Staff do not report incidents to resident's authorized person

Licensing Program Analyst Leibert arrived unannounced for the purpose of delivering findings on the above captioned complaint allegations. LPA met with the Administrator and discussed the findings. This investigation included a thorough review of resident records and other documents; interviews with witnesses and staff; site visits to the facility. The following determinations are made: R1 has fallen and sustained injuries while in care; Facility incorporated fall prevention plan in R1's care plan; Record review indicateas that facility reported incidents per 87211 for R1 on a regular basis; Complainant could not provide sufficient details in order to investigatate a specific incident claimed to have gone unreported; Care notes suggest appropriate responses by care staff to R1's falls; Origins of some falls are unknown but sufficient evidence to link falls to lack of supervision was not found. Although the allegations may be true, based on statements; records and visits, there is not a preponderance of evidence to prove the allegations did or, did not, occur. Therefore, the allegations are UNSUBSTANTIATED.