Complaint Investigation Report

415600964-12-5-2023-14-AS-KHOS-CZ4PQH-20240102103110

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

05/18/2023 and conducted by Evaluator Jaime Vado

COMPLAINT CONTROL NUMBER: 14-AS-20230518124015

- Facility did not have a call system in place and as a result resident was left on the floor for an extended period of time

- Staff did not provide a care plan for resident

On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit to deliver the findings regarding the allegation received. LPA met with Douglas Blake, soon to be administrator, and explained the purpose of today's visit.

During the investigation LPA conducted interviews, reviewed pertinent documents, and made facility observations. It is discovered that the facility does not have a pendant system in place but rather pull cords installed in resident rooms. Per observations there is a call system in place. The facility does have a pendant system in place as well and it is provided to residents that are able to use it on their own and based on their assessments. At the time the resident in this complaint resided in the facility they was not able to manage the pendant. The facility did provide one to the resident at the request of the responsible party but it was not utilized and it would often be found not on the resident due to behavior of removing the pendant and at times would throw it or lose it. Regarding not providing a care plan for resident, LPA received the care plan for the resident that was developed and updated through out the time the resident was in the facility and was provided to the responsible party. These allegations are unfounded.

This agency has investigated the above complaints. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.