Complaint Investigation Report

415601046-9-16-2024-14-AS-ACON-D97TRB-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

On 09/16/2024, Licensing Program Analyst (LPA) Jaime Vado made an unannounced subsequent complaint investigation visit. The purpose of this visit is to provide additional citations related to the already substantiated complaint allegations investigated on and findings were delivered on 08/20/2024.

Upon further review, it was determined additional citations are needed in regards to the allegation findings delivered on 08/20/2024 where a citation was made and delivered on that date. It was found that the facility is responsible for the observation of the resident's change in food and water intake as well as the change in mental and physical changes as an indicator to health conditions discovered as a result of being sent to the emergency room. The resident lost weight while at the facility from 120lbs to 111lbs as well as was dehydrated as found during an emergency room visit made by the resident. Additionally there was a change in the resident's mental condition also found at the hospital These items pose an immediate health and safety risk to residents in care.

As already stated these same allegations were substantiated on 08/20/2024 but additional citations are being issued on this day. Additional citations are cited on the attached LIC9099D.

Report is reviewed with Jovy Castro - Business office manager.