complaint·May 6, 2021

Resident Records reviewed for the period of 4/15/2019 through 2/21/2021 noted that o n 4/15/2019 R1 physical condition was assessed upon admission and observed to have dry skin on both he e ls. On 5/17/2019 R1 was diagnosed with pressure injury to left he e l. Home Health services completed 7 visits from 5/10/2019 through 6/13/2019 for foot care. Treatment was completed on 6/13/2019. There was no reoccurrence of this of pressure injury. R1 continued to receive home health care for the other wounds until August, 2019 when all wounds were completely healed. Home health notes dated 6/28/19 and 8/8/19 stated no wound on legs, and no broken skin and no pressure wound noted respectively . Doctor’s order dated 8/6/19 noted all affected areas appear healed. On 2/12/2020 Home Health notes indicated blister on he e l . R1’s PCP was notified, and no treatment ordered. On 2/13/2020 PCP was updated as to R1’s condition and no treatment ordered. R1 was admitted to hospice services on 2/14/2020. Records indicated R1 had chronic pressure injuries to other areas of R1’s body. R1 was treated at a wound clinic once a week and seen by outside home health medical professionals weekly for assessment and care. Per interview with the resident's primary care physician (PCP), R1 's other pressure injuries were from longstanding case of R1’s medical condition and incontinence. PCP stated that the wounds have been healing. PCP did not feel R1's wounds or injuries were signs of abuse or neglect. The review of police report dated 5/3/19 noted case was closed as there was no indication of adult abuse. The Department has investigated the complaint allegation listed. Based on interviews conducted and records reviewed, the Department has found that the complaint allegation is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. Report reviewed with Brisa Romero Administrator and a copy of this report emailed for signature. Medical records reviewed included Outside Home Health Agency Communications which did not indicate any issues with incontinence care. The Department has investigated the above allegation. Based on information from interviews conducted and records reviewed, although the allegations listed above may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. No Deficiencies cited under California Code of Regulations Title 22 Report reviewed with Brisa Romero Administrator and a copy of this report emailed for signature.