Complaint Investigation Report

306005231-10-25-2022-22-AS-AORZ-CKRNH5-20221101102807

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 770 THE CITY DR., SUITE 7100

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

02/04/2022 and conducted by Evaluator Kevin Saborit-Guasch

COMPLAINT CONTROL NUMBER: 22-AS-20220204135802

1. Resident sustained injuries while in care.

This report was amended. On 07/22/2022, Licensing Program Analyst (LPA) Kevin Saborit-Guasch conducted an unannounced visit to the facility. LPA was greeted and granted entry by caregiving staff who called Rozina Amlani, Administrator, who arrived later to assist with the visit. It was alleged that Resident sustained injuries while in care. During the investigation it was discovered that Resident 1 (R1) sustained an unwitnessed fall on 02/01/2022. Interviews conducted with staff and facility Administrator confirmed that upon finding resident on the floor resident was observed able to stand up unassisted. R1’s responsible party was notified. No medical attention was sought at that time, however, R1 was later that day sent to the hospital after becoming unresponsive to staff. Medical records obtained and reviewed confirmed R1 sustained bruising to face. Per review of medical records submitted my Mission Hospital under subpoena conducted, R1 was noted to be a fall risk. This was later confirmed during an interview with facility Administrator. Therefore, based on preponderance of evidence gathered, the allegation that resident sustained injuries while in care is deemed to be substantiated. The following is being cited per Title 22 Division 6. Exit interview conducted and a copy of report and appeal rights were given to facility representative.