Complaint Investigation Report

342700585-12-30-2022-27-AS-LKIG-CMM47V-20221230175145

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 2525 NATOMAS PARK DR. STE.270

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

09/09/2022 and conducted by Evaluator Renee Campbell

COMPLAINT CONTROL NUMBER: 27-AS-20220909152751

Lack of supervision resulting in resident being outside unattended

On 12/02/22, License Programming Analyst (LPA) Renee Campbell made an unannounced visit to the Indocare 2 Facility at approximately 9:00 am. LPA was met by the Administrator and staff and explained the purpose of the visit. Employee timesheets from August and September of 2022 and the Personnel Report were reviewed. Review of R1’s 602 documented sundowning behaviors, the preplacement appraisal documents night supervision required. LPA reviewed the staffing schedule from August 2022, September 2022 and interviewed staff and the Administrator. The work schedule for all staff revealed there are no awake staff scheduled from 10 pm to 6 am. During that time, “staff are asleep and will only wake up if there is an emergency”, per the Administrator during an interview. S2 reported that she works in the facility most days. LPA asked if she had been present when R1 had wandered. S2 stated “Yes”. S2 explained that since staff were not awake at night, and would not have seen her get up or go out the door at night. LPA asked S2 if she had seen R1 get the black eye. S2 described finding blood in the bathroom one morning and a spot of blood on R1’s bed. S2 saw the black eye but no one witnessed how R1 got the black eye.

Based on LPAs observations, interviews, and record reviews, there is a preponderance of evidence to conclude that the facility does not have awake staff during sleeping hours as required and that R1 sustained unexplained injuries while in care due to lack of appropriate monitoring, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D The Licensee was provided a copy of their rights (LIC9058) and their signature on this form acknowledges receipt of these rights. Exit interview held and a copy of report was given.