Complaint Investigation Report

During the course of the interviews with staff, Staff 3 (S3) reported that R1 is repositioned every two hours and stated that R1 favored positioning back to his right side. Per S4, R1 did not develop a pressure injury due to staff neglect. S5 stated that R1 did not develop pressure injuries due to lack of care or staff neglect.

Based on the information gathered during the investigation and review of documents obtained, LPA is unable to ascertain if the allegation occurred as reported due to conflicting information. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED.

For today’s visit, there were no citations issued per Title 22, Division 6 of the California Code of Regulations.

LPA conducted an exit interview with AD Kornmann, and a copy of this report was provided to the facility.