Complaint Investigation Report

415601046-9-16-2024-14-AS-ACON-D97TRC-20240917145713

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SAN BRUNO RO , 851 TRAEGER AVE., SUITE 360

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

05/14/2024 and conducted by Evaluator Jaime Vado

COMPLAINT CONTROL NUMBER: 14-AS-20240514090937

- Due to staff neglect resident lost weight

- Due to staff neglect resident was dehydrated

*** This amended report was created in error. No changes are made to this report***

On 08/20/2024, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit in order to deliver findings regarding the complaint alletgations received. LPA met with business office manager Jovy Castro and explained the purpose of today's visit.

During the investiation, LPA conducted interviews and reviewed documets pertinent to the investigation such as resident records and medical information. Per the medical documentation reviewed, the resident did lose weight during their time at the facility. Upon admission the weight is documented as 120lbs but after being weighed in a hospital setting the resident weighed 111lbs indicating the weight loss after approximately five weeks. Additionally, the resident was diagnosed with a condition while at the hospital which is a result of dehydration. Upon hospitalization the resident was provided fluids intravenously to aid in hydration. These allegations are substantiated.

Based on LPA interviews and items letters received, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, are being cited on the attached LIC9099D.

Report is discussed with Jovy Castro and a copy of this report is provided on this day.