Complaint Investigation Report

397004012-5-23-2024-27-AS-KHOS-D5XLHV-20240605084657

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SACRAMENTO SOUTH ASC , 9835 GOETHE ROAD, SUITE 100

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

05/08/2024 and conducted by Evaluator Avelina Martinez

COMPLAINT CONTROL NUMBER: 27-AS-20240508103430

Licensing Program Analyst (LPA) Avelina Martinez arrived at the facility unannounced on 05/23/2024 at 12:50 PM to deliver complaint findings, LPA Martinez met with Rebecca Cobb and explained the purpose of the visit.

Throughout the course of the investigation, LPA Martinez conducted interviews and reviewed facility files. The investigation revealed resident 1 (R1) was not administered Insulin per medication orders. R1 was not administered insulin on April 11 thru 14, 2024. On April 15, 2024, R1 was sent to the Emergency Room (ER), which R1 was admitted into the hospital. R1 did not return to River Fountains of Lodi. As a result of this investigation, the Department finds this allegation to be Substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiency cited on the LIC 9099-D page, per Title 22 Regulations. An exit interview was conducted, and a copy of this 809 report, 809D page, and appeals rights were given to the facility.