Complaint Investigation Report

306005207-4-22-2025-22-AS-MSTC-DG96ZX-20250430211550

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

ORANGE COUNTY RO , 770 THE CITY DR., SUITE 7100

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

03/01/2024 and conducted by Evaluator Jerome Haley

COMPLAINT CONTROL NUMBER: 22-AS-20240301162515

Staff did not seek medical attention for resident in a timely manner.

Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit to the facility regarding additional information on the complaint allegation listed above. LPA explained the reason for the visit upon entry.

On October 22, 2024, the department received subpoenaed medical records from West Anaheim Medical Center (WAMC) regarding Resident 1 (R1). A review of the medical records reveal R1 was diagnosed with a stroke.

An Enhanced Civil Penalty is pending determination by Community Care Licensing Division as per Health & Safety Code 1569.49(f).

The facility was cited per Title 22, Division 6 of the California Code of Regulations. An amended deficiency is being cited on the attached LIC9099D. An immediate Civil Penalty is being assessed today in the amount of five hundred dollars ($500).

An exit interview was conducted, and a copy of this report, a copy of Civil Penalty Assessment Form and appeal rights was provided.