Complaint Investigation Report

240403819-3-4-2024-24-AS-BCHN-D35QYQ-20240307113527

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

08/16/2023 and conducted by Evaluator Sarah Hurt

COMPLAINT CONTROL NUMBER: 24-AS-20230816145449

Staff did not seek timely medical care for resident in care

Staff did not follow proper reporting requirements

Licensing Program Analyst (LPA) Sarah Hurt arrived at the facility unannounced on 02/20/2024 at 02:00 p.m. to deliver findings on the above allegations. LPA met with facility Program Director, Katherine Coleman and explained the purpose for today’s visit.

Regarding the allegation Staff did not seek timely medical care for resident in care. Client 1 had several falls at the facility on 08/09/2023 resulting in a fractured femur. Facility staff present did not examine Client 1 for physical signs of injury, resulting in delayed medical care. Based on LPAs interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED

Regarding the allegation Staff did not follow proper reporting requirements. Facility staff did not contact Responsible Party for Client 1 on 08/09/2023 to inform them of Client 1's falls at the facility . Based on LPAs interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED

The following deficincies are being cited Per Title 22 Regulations.

Exit interview conducted with Program Director, Katherine Coleman, and a copy of this report along with appeals rights provided.