Complaint Investigation Report

392700306-12-7-2021-27-AS-LKIG-C9SNKK-20211217093204

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

11/01/2021 and conducted by Evaluator Bruce Jacobs

COMPLAINT CONTROL NUMBER: 27-AS-20211101101635

Facility did not have sufficient overnight staff

Licensing Program Analyst (LPA) Bruce Jacobs arrived at the facility and met with Administrator Katrice Collins to deliver investigation findings on the above allegation. This investigation consisted of site inspections to the facility to conduct interviews with the facility administrator, staff, residents and other witnesses. LPA reviewed and obtained copies of the resident's (R-1) file, a staffing schedule and other documentation.

This investigation concluded that on the overnight shift on August 16, 2021, the facility had insufficient staffing. On this shift, the care home had scheduled two staff for 54 residents. One staff called in sick and the facility was unable to fill the position. During the night, a resident fell out of bed and the staff was not able to lift him back up and the Fire Department was called for lift assist.

As a result of this investigation, LPA finds the allegations to be (S) Substantiated - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following deficiencies are cited on 9099-D, per Title 22 Regulations, Division 6.

Exit interview conducted and report provided. Appeals rights printed.