Complaint Investigation Report

419210057-10-13-2023-14-AS-KHOS-CWNNVS-20231016104825

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SF COASTAL AC/SC , 851 TRAEGER AVE., SUITE 360

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

02/15/2023 and conducted by Evaluator Jaime Vado

COMPLAINT CONTROL NUMBER: 14-AS-20230215144137

- Client in care sustained an unexplained injury

- Staff did not inform client's authorized representative of client's incident

On this date Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit in order to deliver findings regarding the allegations received. LPA met with administrator Czarina Navarro and explained the purpose of today's visit.

During the course of the investigation LPA conducted interviews and reviewed the records of C1. It is discovered that prior to admission to the facility C1 sustained injuries at a previous facility requiring surgery. Due to C1 cognitive levels and non-verbal status the was staff was unaware of anything specific that may have led them to believe an injury may have been sustained. Facility did send C1 to the hospital at least three times for evaluation and determinations at the hospital did not indicate any injuries that may have led to C1 favoring a wheel chair. There was no injury to report to the responsible party. This allegation is unsubstantiated.

Therefore, based on the interviews conducted and information collected, the allegation is UNSUBSTANTIATED, meaning that although the allegation may have happened or is valid, there is no preponderance of evidence to prove that the alleged violation occurred.

Report is reveiwed with adminstrator Czarina. No citations issued.