complaint·July 8, 2021

The investigation revealed the following: Allegation: Staff did not provide timely medical assistance. On 06/15/2021 LPA Jose Calderon interviewed Administrator (S1) who stated R1 injured R1 right index finger while using R1 wheel chair. S1 states that R1 was assessed by RN when they became aware of the injury and then transported to the hospital for evaluation. On 06/15/2021 and 07/01/2021 LPA Calderon interviewed S2-S6 for complaint, all state they were aware of R1 injury to the finger, but also state that they took care of R1 needs, but R1 finger was not getting better, and R1 was moved to the hospital for more care. On 06/14/2021 and 06/16/2021 LPA Calderon interviewed Witness (W1) and W1 stated that when W1 visited R1, W1 noticed gangrene on the right index finger. W1 took R1 to Kaiser hospital. On 06/15/2021 LPA Calderon interviewed R1 for complaint, he states an unknown person pushed R1 down a ramp inside the facility and R1 injured his finger on his wheel chair. On 06/15/2021 LPA Calderon requested copies of the following: Staff and Resident Roster, Needs and Service plan, Physician Report, medical reports for past 3 months, Medication list, SIR reports for 3 months and Kaiser Hospital records for R1. On 07/02/2021 received and reviewed Kaiser Medical Records for R1. The review of the medical records revealed that R1 did not have gangrene or an infection. Based on interviews conducted and records the facility provided basic first aid for an injury and R1 was taken to the hospital when the injury worsened. Allegation: Resident developed an infection on hand On 06/15/2021 LPA Jose Calderon interviewed Administrator (S1) who stated R1 injured R1 right index finger while using R1 wheel chair. S1 states that R1 was assessed by RN and then transported to the hospital for evaluation. On 06/15/2021 and 07/01/2021 LPA Calderon interviewed S2-S6 for complaint, all state they were aware of R1 injury to the finger, but also state that they took care of R1 needs, but R1 finger was not getting better, and R1 was moved to the hospital for more care. On 06/14/2021 and 06/16/2021 LPA Calderon interviewed Witness (W1) and W1 stated that when W1 visited R1, W1 noticed gangrene on the right index finger. W1 took R1 to Kaiser hospital. On 06/15/2021 LPA Calderon interviewed R1 for complaint, he states an unknown person pushed R1 down a ramp inside the facility and R1 injured his finger on his wheel chair. On 06/15/2021 LPA Calderon requested copies of the following: Staff and Resident Roster, Needs and Service plan, Physician Report, medical reports for past 3 months, Medication list, SIR reports for 3 months and Kaiser Hospital records for R1. On 07/02/2021 received and reviewed Kaiser Medical Records for R1. The review of the medical records revealed that R1 did not have gangrene or an infection. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted with Administrator Peggy Clark, and a hard copy was provided for records.