Complaint Investigation Report

On 07/29/2023, LPA Martha Arroyo conducted an initial 10-day complaint visit. During the visit, at 8:30 a.m., LPA conducted a physical plant tour to ensure there were no health and safety concerns. Between 8:04 a.m. and 10:03 a.m., the LPA conducted interviews with the administrator, one staff member, and three residents. At 8:55 a.m., the LPA conducted a resident file review and obtained copies of pertinent documents relevant to the investigation. LPA Arroyo also conducted one staff interview on 08/15/2023 at 3:13 p.m. and telephonic interviews with family members on 11/30/2023 at 10:13 a.m. and 10:55 a.m.

Investigator Bendana conducted interviews on 08/25/2023, at approximately 2:12 p.m., with R1’s resident representative; on 08/28/2023, at approximately 10:24 a.m., with the reporting party; on 09/12/2023, from approximately 11:02 a.m. to 11:35 a.m., with Staff #1 (S1), Staff #2 (S2) and residents; on 09/21/2023, at approximately 9:42 a.m., with the administrator; and at 10:28 a.m. attempted to interview R1, however, R1 declined to be interviewed. In addition, the investigator reviewed Adventist Health Simi Valley Hospital medical records and facility file documents related to R1.

A review of R1’s Physician Report, dated 06/13/2023, lists R1’s primary diagnosis as dementia. The secondary diagnosis is listed as osteoporosis, macular degeneration. The report noted R1 has a visual impairment, uses a walker and is a fall risk. The Preplacement Appraisal Information, dated 6/28/2023, indicates R1 is not able to walk without any physical assistance, is feeble or slow, uses a walker, is unsteady and needs assistance with all activities, even basic activities. R1 is at risk for falls, needs help transferring in and out of bed and dressing; needs help with bathing, hair care and personal hygiene; needs help with moving about the facility; needs assistance with toileting including equipment assistance or assistance of another person; and R1 needs special observation/night supervision due to confusion, forgetfulness and wandering.

A review of R1’s hospital medical records revealed R1 was admitted to Adventist Health Simi Valley Hospital on 07/22/2023, with the chief complaint of an unwitnessed fall, and left femur deformity. R1 was found to have a femur (hip) fracture and orthopedics were consulted. R1 had surgery to the left femoral shaft fracture intramedullary nailing. R1 was discharged to a Skilled Nursing Facility (SNF) on 07/27/2023 for rehabilitation. (Report Continued on LIC 9099C...)