Facility Evaluation Report

Licensing Program Analyst (LPA) Christina Valerio arrived on November 19 th , 2021 for an unannounced case management to follow up on a substantiated complaint investigation. LPA met with Annie Rodriguez, Representative of 5M Care LLC and stated the purpose of the visit.

On April 17, 2020, the Department concluded a complaint investigation which alleged the following: Staff did not seek medical attention in a timely manner; resident (R1) sustained an unstageable pressure injury and unexplained fracture while in care.

The allegation was substantiated, and the licensee was cited for violating California Code of Regulations (CCR) Title 22, § 87615(a)(1) Prohibited Health Conditions, § 87465(g) Incidental Medical and Dental Care Services. The facility did not seek medical attention timely and also retained R1 for 14 days with an unstageable pressure injury without a hospice referral from a physician nor did they request an exception from the Department.

The investigation revealed that on December 6, 2019 the R1, sustained an acute comminuted and displaced proximal left tibial metaphyseal fracture (Left knee fracture) while being transferred with the assistance of staff (S1 and S2). On December 6, 2019, R1’s responsible party went to the facility and observed swelling below the left knee and contacted R1’s Primary Care Physician (PCP). R1’s responsible party and the facility was informed by the PCP, to monitor R1’s knee and see how it looks on December 9, 2019, and in the interim to use a cold compress and pain medication. No other instructions or patient care was advised by the PCP at this time. On December 13, 2019, the facilities Daily Reports indicate that R1 could not move their left leg. The facility did not seek medical attention between December 9, 2019, through December 19, 2019, after seeing increased swelling.