Complaint Investigation Report

342701159-1-25-2023-27-AS-KHOS-CNFRSF-20230126121640

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SACRAMENTO AC/SC , 2525 NATOMAS PARK DR. STE.270

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

11/22/2022 and conducted by Evaluator Kesha Lewis

COMPLAINT CONTROL NUMBER: 27-AS-20221122143911

Resident sustained pressure injury while in care

LPA Kesha Lewis conducted a complaint visit to this facility today to conclude a complaint for the allegations listed above. LPA met with Staff and Licensee and explained the purpose for today's visit.

Interviews with staff, interviews with outside care takers and documentation were reviewed that included chart notes and medical files. According to medical file reviews, chart note reviews and physician order reports, as well as staff interviews, Resident 1 (R1) sustained a unhealing wound while in care. Based on interviews with 1 staff members and one outside caretaker, R1 did sustain a pressure injury while in care of the facility. During review of medical files. LPA did discover R1 had sustained an unhealing wound. Therefore, the allegation: Resident sustained pressure injury while in care is Substantiated.

Based on LPAs observations and interviews which were conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

California Code of Regulations (Title 22, Division 6, Chapter 8) are being cited on the attached LIC 9099D.

Exit interview held, a copy of report will be emailed as LPA'S printer is not working at this time.