complaint·October 5, 2022

[CONTINUED FROM LIC 9099] According to staff interviews and facility/hospital records, on 06-30-2020, licensee sent R1 to a hospital emergency room (ER) for vaginal bleeding and suspected prolapsed uterus. Per an LIC624 Incident Report licensee filed with the CCLD San Diego Regional Office (RO): facility Staff #1 (S1), Staff #2 (S2), Staff #3 (S3), and Staff #4 (S4) had contact with R1 before they left for the hospital. At this time, R1 denied pain, had no apparent bruising on their face/body, had no recent fall, and there was nothing abnormal about their arms. The absence of any sign/symptom of an arm injury on R1 was corroborated by interviews of S1 and S2. S2 even performed a thorough “head-to-toe assessment” of R1 prior to their departure to the hospital. (Meanwhile, S3 clarified to CCLD that they did not see R1 on 06-30-2020. By the time of investigation, S4 had left employment and did not have a working telephone number where they could be reached for interview). Facility managers S1 and Staff #5 (S5) said R1’s most recent known fall occurred in October 2019, which was nearly eight months prior to this incident; this was consistent with R1’s hospital records. Upon R1’s arrival to the ER on 06-30-2020, the hospitalist, Physician #1 (P1), performed a physical exam on them. P1 wrote of R1’s right wrist, “Normal.” P1 wrote of R1’s right elbow, “Normal. [They] exhibit normal range of motion, no swelling, no effusion, no deformity, and no laceration. No tenderness found. No radial head, no medial epicondyle, no lateral epicondyle and no olecranon process tenderness noted.” P1 wrote of R1’s right shoulder, “Normal. [They exhibit] normal range of motion, no tenderness, no bony tenderness, no swelling, no effusion, no crepitus, no deformity, no laceration, no pain, no spasm, normal pulse, and normal strength.” P1’s assessment did not find any bruising on R1’s face or body. Later that evening, X-rays were done on R1, revealing a “minimally displaced oblique fracture” of the right humerus bone (i.e. right upper arm). [CONTINUED ON LIC 9099-C, 2 of 2] [CONTINUED FROM LIC 9099-C, 1 of 2] P1 said R1’s arm fracture did not warrant surgery because it should heal on its own after eight weeks. P1 said they personally interviewed hospital staff, facility staff, and an outside source, but no one knew where, when, or how R1 sustained their arm fracture. According to their LIC602 Physician’s Report, and corroborated by hospital records, R1 had been diagnosed with Osteoporosis (a progressive condition causing bones to become weak and brittle) since January 2011. A San Diego Sheriff’s Department patrol deputy investigated the incident and wrote “the doctor determined the fracture was not a recent injury due to the lack of bruising on the exterior of the skin and other factors.” This was generally consistent with the written assessment of the hospital’s radiologist, Physician #2 (P2), who wrote, “No significant soft tissue abnormality is noted.” A Sheriff’s detective reviewed the case and told CCLD there was no evidence to suggest that R1’s arm fracture occurred at licensee’s facility, any more than it could have happened at the hospital or somewhere else. The detective said it did not meet criteria for filing with the county District Attorney and closed the case. According to hospital records, R1 was prescribed a sling for their arm and discharged back to the facility on the afternoon of 07-01-2020 via outside medical transport. S2 said they again performed a head-to-toe assessment on R1, this time finding new bruises on R1’s face, knee, and elbow (none of which was present prior to R1 going to the hospital). R1’s new bruises were corroborated in interviews of S1 and S5, and documented in a second LIC624 Incident Report which licensee filed with the RO on 07-01-2020. Furthermore, S1 said when they asked R1 how they broke their arm, R1 said they “fell at the hospital,” but could not provide any more detail. According to R1’s LIC602 Physician’s Report, their “primary diagnosis” is “dementia,” but they were “able to follow instructions” and “able to communicate needs.” Based on interviews and records, a preponderance of evidence does not exist to prove licensee’s culpability for R1’s right arm fracture, or licensee’s failure to observe R1 during their time at the facility. The allegation is therefore unsubstantiated. An exit interview was conducted with Dickmann, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 01/16) were provided.