Complaint Investigation Report

547208780-1-8-2025-24-AS-KHOS-DCWQ7Z-20250114105558

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

10/17/2024 and conducted by Evaluator Lisa Salazar

COMPLAINT CONTROL NUMBER: 24-AS-20241017090403

Staff due not ensure residents health care needs are being addressed

On 01/07/25, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to deliver findings on the above allegation. LPA was greeted by staff, introduced self, stated the purpose of the visit, and was allowed entry into the facility. LPA met with Administrator to discuss the findings.

During the investigation, LPA conducted interviews and records review. On 10/04/24, day program staff called emergency services due to R1 having abnormal breathing. R1 was taken to the hospital via ambulance, diagnosed with an infection, treated and released home. On 10/15/24, R1 was observed to be wheezing and out of breath when they arrived at day program. S1 was advised by the day program that emergency services would be called for medical attention based on their observations of R1. R1 returned home and was reported to have no further wheezing. No medical attention was sought.

LPA observed Resident R1’s medical assessment (LIC 602) dated 08/16/24 to be incomplete and did not identify R1’s special problems and needs, prescribed medications being taken, or current medical status. Needs and Service appraisal/reappraisal was not observed in R1's file indicating the care and supervision needs of R1.

Based on the information received and per California Code of Regulations, Title 22, Division 6 Chapter 1, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. A deficiency is being cited on the attached LIC 9099D. An exit interview was conducted with Administrator, and a Plan of Correction was developed and reviewed by LPA with a due date of 01/08/25. A copy of this report and appeal rights were provided at the time of visit.