Complaint Investigation Report

360900521-12-28-2022-56-AS-KCLS-CPKTN6-20230303135213

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 1650 SPRUCE ST STE 200 MS29-27

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

12/22/2022 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 56-AS-20221222140837

Resident fell multiple times sustaining injuries

Licensing Program Analysts (LPA) Bernadette Allen made an unannounced visit to the facility for the purpose of initiating and delivering findings on the complaints above. LPA met with Keely Administrator who was informed of the purpose of my visit and the allegation above.

Allegation #1 -Resident fell multiple times sustaining injuries

LPA interview three (3) staff members who confirmed that resident 1 (R1) has fallen several times which has caused scars to (R1) legs and forehead. Based on record review and observations during LPA visit the resident has falling several times and sustained injuries while in care. Based on observation and record review as to allegation that the resident has fell multiple times and sustained injury is substantiated.

A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. A deficiency is being cited on the attached LIC 9099-D.