Complaint Investigation Report

547206596-12-21-2022-24-AS-SMOA-CMKMHL-20221229083739

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

10/07/2022 and conducted by Evaluator Mai Yang

COMPLAINT CONTROL NUMBER: 24-AS-20221007131548

Administrator Lenette Otero-Gross and Health and Wellness Director Megan Mike

Resident sustained fracture and was hospitalized due to staff’s neglect

On 12/21/22, Licensing Program Analyst (LPA), M. Yang arrived at the facility unannounced to deliver complaint finding and stated the purpose of the visit and granted entry. LPA met with Administrator Lenette Otero-Gross and Health and Wellness Director Megan Mike.

During the course of the investigation, the Department conducted interviews, records were reviewed and based on review, the preponderance of evidence standard has been met, therefore the allegation that Resident 1 (R1) sustained fracture and was hospitalized due to staff neglect is SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, a deficiency is being cited on the attached Lic 9099D. A violation regarding care and supervision warrants an immediate civil penalty. An immediate civil penalty of $500 is assessed. The issuance of additional civil penalties is pending and currently under review. The details of additional civil penalties will be outlined in a future report to the facility, if any. An exit interview was conducted. A copy of this report and appeal rights was provided to Administrator.