Complaint Investigation Report

286802019-5-26-2022-21-AS-KMOA-CEZUG8-20220602153356

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

02/15/2022 and conducted by Evaluator Erik Gonzalez Campos

COMPLAINT CONTROL NUMBER: 21-AS-20220215144846

Facility retained a resident with a prohibited condition

Licensing Program Analyst (LPA) Erik Gonzalez Campos conducted an investigation regarding the allegation above. LPA arrived unannounced on 05/26/2022 to deliver complaint findings.

On 02/15/2022 Community Care Licensing recieved a report that resident was admitted to the hospital from the facility with a pressure injury. LPA conducted interviews with hospital staff who indicated injury was documented at admission and photographs were taken. LPA requested Investigations Branch (IB) request documentation from hospital. Review of hospital records revealed that resident was admitted with an unstageable wound, a prohibited health condition. Based on the investigation, the preponderance of evidence standard has been met, therefore the above allegation has been SUBSTANTIATED.

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.