Complaint Investigation Report

312700739-10-16-2024-59-AS-MSEY-DA5U8G-20241017152128

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SACRAMENTO NORTH ASC , 9835 GOETHE ROAD, SUITE 100

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

07/15/2024 and conducted by Evaluator Sabrina Calzada

COMPLAINT CONTROL NUMBER: 59-AS-20240715140347

Staff did not prevent resident from being harmed by another resident which resulted in injury.

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver findings to a complaint received on 7/15/24. LPA met with Henry Cole, Administrator, and stated the reason for the inspection. LPA was on site most of the day to conduct a required annual inspection also.

The Department conducted an investigation into an incident on 7/13/24 (7:51 am), between residents (R1/R2) in the Memory Care dining room. Interviews were conducted, video surveillance was viewed along with police and hospital records. Video surveillance showed multiple staff had intervened in less than (20) seconds and within (2) minutes, both residents were being assisted with walking out of the dining room. The police were contacted due to (R1) returning to the dining room and yelling. (R1) returned from the hospital the same day at 1:30 pm. (R2) was redirected and assigned a 1:1 for 48 hours to monitor behavior. Based on review of police and hospital medical records, it was determined that an egregious injury was not sustained by (R1).

Based on information obtained, the Department has determined the allegation to be UNSUBSTANTIATED- meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.