Complaint Investigation Report

306006057-10-28-2025-22-AS-MSTC-DNT4ST-20251126182205

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

10/20/2025 and conducted by Evaluator Jerome Haley

COMPLAINT CONTROL NUMBER: 22-AS-20251020134502

Facility failed to report and provide updates on the residents health status.

Regarding the allegation: Facility failed to report and provide updates on the residents health status.

During the investigation, it was confirmed by S1, there was a breakdown in communication and the family of R1 was not informed about the residents change in condition. Facility staff did not inform the responsible person about the swelling to the residents legs that led to the residents hospitalization. S1 also confirmed there was no incident report sent to the Regional Office regarding the hospitalization of R1.

Based on the evidence gathered through interviews, and document review the preponderance of evidence standard has been met, therefore, the allegation above is found to be SUBSTANTIATED. A violation is being cited per California Code of Regulations Title 22.

An exit interview was conducted, and a copy of this report and appeal rights were provided.