complaint·March 22, 2022

During interview, witness stated R1 was fine on 07/16/2021 and did not notice any injuries when R1 was given a full bath. During interview, facility staff suspected the injury was caused unintentionally during transfer or repositioning only because they could not identify any obvious explanations, like a fall or intentional harm by staff. Based on hospital medical records, R1 was admitted to the hospital from 07/17/2021-07/20/2021 for a “closed displaced oblique fracture, of shaft of right humerus fracture.” Based on records review, interviews with staff and witnesses, and observations there is preponderance of evidence to prove the alleged violation did occur, therefore the allegation is substantiated. See LIC9099-D for deficiencies cited per the California Code of Regulations, Title 22. This report was reviewed with Administrator Yadira Gonzalez-Mendoza and a copy of the report and appeal rights were provided. Page 2 of 2.