complaint·June 5, 2025

Continued from LIC9099 Community Care Licensing (CCL) received an incident report on 04/14/2023. Report stated that on 04/13/2023, R1 was observed by facility staff to have swollen feet and skin discoloration on their right leg. Per report received, facility staff notified R1’s responsible party via phone call and contacted Emergency Services for further evaluation. Facility progress note stated that on 04/13/2023, facility staff observed R1’s knee to be swollen and bruised, and when touched, R1 exhibited pain. Progress note also stated that facility staff notified R1’s responsible party and sent a text message of their observations to the responsible party and contacted emergency services. Review of documentation showed that R1 did not have an SOC-341 or abuse report filed in April 2023 by the hospital or other entities. Interview conducted with Witness 1 (W1) revealed that facility protocol is to contact the resident’s primary responsible party. If the primary responsible party is unavailable, then the facility is to contact the secondary responsible party. W1 was unable to recall any additional details of R1’s incident. Interview conducted with Witness 2 (W2) did not reveal any additional information as they were unable to recall details of R1’s incident. Facility documentation indicated that facility maintenance Director reviewed the video camera system and did not observe R1 to have a fall. LPA was unable to review the video footage as the facility camera system only archives up to 90 days and the incident occurred on April 13, 2023. Due to lack of evidence, the Department is unable to determine if there was a violation of Title 22 Regulation, therefore, these allegations are Unsubstantiated . A finding that the complaint allegation is Unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Exit interview conducted. Copy of report discussed and provided to Executive Director. Signature on form confirms receipt of documents.