Complaint Investigation Report

547200844-8-7-2024-24-AS-SMOA-D93KJY-20240913075727

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

03/25/2024 and conducted by Evaluator Kamaldeep Kaur

COMPLAINT CONTROL NUMBER: 24-AS-20240325154638

Staff performed unsafe transfers resulting in resident sustaining injuries

Staff handled residents in a rough manner

On this date, Licensing Program Analyst (LPA) K. Kaur arrived at the facility for a subsequent visit to deliver findings. LPA met with Administrator Katrina Sinift and explained the purpose of the visit and reviewed the elements of the allegations. LPA delivered the following complaint investigation findings.

The Department conducted interviews and reviewed records. Based on the interviews conducted and records reviewed, the resident sustained multiple bruises and skin tears due to one-person assist instead of following the care plan of 2 person assist. Based on staff and resident interviews staff speak inappropriately to residents and handle the residents in a rough manner as well as threatening residents when they complain. The preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED.

Citations are issued per Title 22 on the attached LIC9099D page. Citations regarding unsafe transfers was addressed during NCC meeting and cited on another complaint. Exit interview was conducted with Administrator and appeal rights were provided.