Complaint·February 21, 2023

While at the hospital and upon presentation, ER nurse also reported unstageable pressure injuries found on R1’s leg and ankle. Detailed wound care instructions, a home health (wound care) referral and a set of moon booties were sent with R1 to the facility. Wound care nurse visits were scheduled weekly at the facility and the wounds mostly healed. The preponderance of evidence has been met. Therefore, the allegation that resident sustained injuries while in care is substantiated. Immediate civil penalty of $500 is being assessed on today’s visit. Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted. Appeal Rights and a copy of this report provided via email.