Complaint Investigation Report

306006040-3-20-2023-22-AS-SSAS-CQ5U3J-20230321151338

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

08/11/2022 and conducted by Evaluator Michelle Reed

COMPLAINT CONTROL NUMBER: 22-AS-20220811134259

Resident sustained multiple falls while in care due to lack of supervision

Licensing Program Analyst Michelle Reed arrived at the facility to deliver the findings of this complaint investigation. Upon arrival, LPA met with Administrator Jennifer Kornmann. The complaint was investigated and consisted of interviews with the facility staff, Administrator, and a review of Resident #1’s records. The following was determined:

Resident #1 (R1) was admitted into the facility on 12/3/21. R1 resided in the Assisted Living building.

On 8/11/22, at approximately 6:15am, R1 had an unwitnessed fall in his room. Staff immediately called 911 and R1 was taken to the hospital for evaluation. R1 did not receive any injuries. Records reviewed disclosed that R1 had a series of falls prior to 8/11.

Based upon the interviews conducted and the records reviewed, the allegation is unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that R1’s falls were due to lack of supervision. An exit interview was conducted and a copy of this report was provided to Jennifer Kornmann.