Complaint Investigation Report

496804017-11-22-2022-21-AS-CMAZ-CLEV8F-20221122151237

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 1450 NEOTOMAS AVENUE, STE. 100

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

05/31/2022 and conducted by Evaluator David Leibert

COMPLAINT CONTROL NUMBER: 21-AS-20220531090701

Resident sustained an unwitnessed fall resulting in injuries while in care.

Resident sustained skin tears while in care.

Licensing Program Analyst Leibert arrived unannounced for the purpose of delivering findings on this complaint. LPA met with Lydia Gravelynand discussed findings. This Department has investigated allegations by conducting interviews; reviewing documents and photographs; making site visits to facility. The following determinations are made: R1 sustained unwitnessed fall on 1/19/2022; initial assessment of 1/11/2022 notes R1 can transfer independently and does not require assistance; Staff report that R1 had been checked prior to fall within the hour; Staff summoned medical attention and made the required notifications. On 5/17/2022, staff noted a fresh skin tear on R1; Facility LVN assessed and dressed the tear and made required notifications; Seen by a MD on 5/23/2022, R1 was noted to have no signs of infection or abuse; MD reports that the injury consistent with a fall. This Department has investigated the complaint allegations and, based upon the statements taken and documents reviewed, we have determined that the complaint is UNFOUNDED, meaning that the allegations are false and/or, are without a reasonable basis. The complaint is DISMISSED. Report left.