Complaint Investigation Report

455002633-11-20-2024-59-AS-KHOS-DBCJAT-20241125055315

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

SACRAMENTO NORTH ASC , 9835 GOETHE ROAD, SUITE 100

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

08/08/2024 and conducted by Evaluator Ivan Avila

COMPLAINT CONTROL NUMBER: 59-AS-20240808154742

Resident fell multiple times due to staff neglect resulting in injuries

On 11/20/2024 Licensing Program Analyst (LPA) Ivan Avila conducted an unannounced complaint investigation visit regarding the above allegation directed by the Department. LPA met with Tricia Cockrum and explained the purpose of the visit.

During the investigation process, interviews and a records review were initiated.

LPA investigated the allegation, “Resident fell multiple times due to staff neglect resulting in injuries.” Based on record review and interviews conducted, R1 sustained multiple falls at the facility. R1 had also sustained some minor injuries. R1 had fallen from her bed after staff forgot to adjust the resident’s bedrails causing R1 to fall from the bed.

Based on LPAs observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, and the California Health and Safety Code are cited on the attached LIC9099-D.

An exit interview was conducted, and a copy of the report and appeal rights were provided.