Complaint Investigation Report

486803822-12-2-2021-21-AS-HDBI-C9S435-20211216174409

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 101 GOLF COURSE DR. STE. A-230

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

08/17/2021 and conducted by Evaluator David Leibert

COMPLAINT CONTROL NUMBER: 21-AS-20210817084613

Resident sustained a fracture during care

Facility failed to provide care resulting in resident injury

Licensing Program Analyst Leibert arrived unannounced for the purpose of delivering findings on this complaint. LPA met with Tonya Tucker Tafolla and discussed the findings. During the course of this investigation statements were taken, records were obtained and reviewed, and site visits completed. Based upon the statements and records, the following determinations are made: R1 fell and sustained a fracture during a supervised class at the facility; It is alleged that the injury resulted from a lack of care and supervision by facility staff; R1's medical assessment indicates non ambulatory, lacking significant mental impairment, no limitations of physical activity; R1's Care Plan indicates independent for locomotion, stand by assistance with dressing; Witnesses to the fall have not provided evidence to suggest it resulted from a lack of care or supervision; R1 does not recall details of the incident. Although the allegations may be true, based upon the records reviewed and statements taken, there is not a preponderance of evidence to prove or disprove the allegations. Therefore, the allegations are UNSUBSTANTIATED.