complaint·September 28, 2021

..Continued from LIC 9099 LPA Valerio reviewed four random resident files. The resident files reviewed were residents present during the month of April 2021 and May 2021. Based on the review the resident's LIC 602 Physician Report, Incident Reports, and medical records, LPA Valerio observed 2 out of 4 residents sustaining injuries. R2 sustained multiple rib fractures after an incident involving a fall. R3 sustained three rib fractures, unexplained bruising on arms, unexplained bruising under breast, and unexplained bruising on body. LPA Valerio later discovered from an interview conducted with Responsible Party for Resident 4 (RPR4) that R4 sustained injuries while in care at ACC Maple Tree Assisted Living. RPR4 removed the resident from the facility based on R4's doctor recommendation. R4, whom was non-ambulatory, was left alone in R4's room causing R4 to fall. R4 sustained bruising along arms and body, a rib fracture, and face injuries, which required sutures. Based on medical record review, interview, and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8) are being cited on the attached LIC-9099D. Failure to correct the deficiency may result in civil penalties. Appeal rights were provided. An immediate $500 penalty is being issued today. At the time of the conclusion of this complaint investigation, the issuance of a Civil Penalty was still being determined. However, the Licensee was informed that a Civil Penalty may be assessed based on Health & Safety Code section 1569.49 (1). An exit interview was conducted, and a copy of the report was provided to Administrator Harumi Hurrianko. This document was amended to include an issuance of an immediate $500 penalty and to disclose that an issuance of a Civil Penalty was still being determined.