complaint·May 17, 2022

Medical records were requested by the office of Investigations. The records were received and reviewed on 04-22-2019 by Investigator Douglas. Additionally, on 4/10/2019 and 7/1/2019 Investigator Douglas conducted interviews with, administrator, staff and other relevant parties. The investigation revealed that on 03-17-2019 Resident #1(R1) was showing signs of pain in the hip and or leg. The resident was unable to express pain verbally. Facility staff members attempted to assess the resident to find out what was hurting by the resident’s reaction when the resident was moved. The staff logs indicate that R1 complained about pain on the left hip and leg on 03-18-2019. In-addition the resident had a temperature of 102 degrees and appeared to show signs of abdominal pain. At which time the family was notified. Staff interviews revealed resident had previous falls approximately 3 weeks prior, staff denied R1 sustained a recent fall and denied knowing the cause for the recently developed pain. On 03-19-2019 the Administrator had spoken to a Kaiser Nurse Practitioner who recommended that R1 be sent to the hospital, to which the facility Administrator initially declined. The Administrator acknowledged it was ultimately the resident’s family/POA (Power of Attorney) to have R1 transported to the Kaiser hospital as a precaution. Additionally, on 3/17/2022 LPA Avetisyan requested Pre hospital Care Report Summary from the Los Angeles Fire Department Emergency Medical Services. Records were received and reviewed on 3/30/2022. According to the paramedic documentation they responded to a call for a 71 year old with complaint of left hip pain from ground level mechanical fall. Reviewed medical records revealed upon hospitalization X-rays of R1’s left hip were taken. The x-rays indicated that R1 sustained mildly displaced/impacted fracture of the femoral neck. Staff interviews confirmed that R1 was complaining of pain for about 3 days and administrator declined to obtain medical care. Medical care was obtained at the request of R1’s POA. Therefore, the allegations of Resident 1 (R1) sustained an unexplained fracture while in care and Licensee/Staff failed to seek timely medical attention are substantiated. Per California Code of Regulations (CCR), Title 22, see LIC 9099-D for deficiencies cited. Exit Interview Conducted / Appeal Rights Discussed / A Copy of the Report Issued.