Complaint Investigation Report

547201120-10-15-2021-24-AS-MHON-C932BS-20211123161536

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

04/21/2021 and conducted by Evaluator Melinda Medina

COMPLAINT CONTROL NUMBER: 24-AS-20210421125758

Resident pushed another resident causing injury

Licensing Program Analyst (LPA) M. Medina conducted a subsequent visit to facility to investigate complaint. LPA identified herself and discussed the purpose of visit with Licensee, Melanie Tantingco. Also present during complaint visit was Administrator, Esmeralda Coronado.

LPA conducted interviews, and reviewed documentation received during complaint investigation. There was an incident reported involving R1 stating R1 tripped due to shoes they were wearing, causing injury to chin. This information is also noted in facilities computer based logging system. There is no reference to an incident between R1 and R2 as reported to Department by complainant. Per Administrator, residents who are incontinent are checked every two hours and changed as needed but there is no documentation charted in resident files. LPA was unable to interview residents due to physician diagnosis and inability to answer questions.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted. No deficiencies cited.