Complaint·March 11, 2026

On 01/09/2026, LPA Partoza interviewed 2 staff. Staff 2 (S2) stated that R1 was observed with tiny bruises 6 months ago and was reported to R1s PCP. Staff 3 (S3) stated that R1 bruises easily and does not know how R1 gets the bruises. On 02/05/2026, LPA Partoza interviewed W2. W2 stated that the facility did not notify R1s responsible party (RP) of the injury that R1 sustained a wound when R1 hit his/her foot on the wheelchair, however, W2 stated that “staff at the facility are typically good at reporting this type of incident to R1s RP.” W2 stated that the facility notified RP via phone on 08/28/2025, that R1s foot had a fluid filled blister on the left heel. Based on R1s general chart notes from 07/12/2025 to 08/27/2025 there was no incident reported describing a wheelchair related injury, however, documentation from 08/25/2025 to 08/27/2025 noted lethargy and poor appetite. On 08/28/2025, general chart notes documented discovery of a blister, photo taken, and notification to the responsible party (RP), primary care physician (PCP) and former memory care director (MCD). Additional information that RP and PCP were notified later the same day. The facility reported the incident to Community Care Licensing Division (CCLD) on 09/02/2025. Based on the R1s medical assessment dated 08/29/2025 R1s injury described a “serious foot injury requiring medical intervention.” Based on the policy review, the facility has a reporting policy consistent with California Code of Regulations (CCR) Title 22 section §87211, which requires facilities to notify the Department, the resident’s responsible party, and other appropriate agencies of incidents that pose a risk to resident health, safety, or personal rights. During the investigation, documentation disclosed that the facility notified the responsible party (RP), primary care provider (PCP), and memory care director (MCD) on 08/28/2025 when R1’s left heel blister was discovered and later submitted the incident report to the Department on 09/02/2025, consistent with the reporting timelines and procedures outlined in CCR §87211. page 2 of 3 see LIC 9099C Based on interviews and record review, the facility demonstrated compliance with its reporting obligations as required under §87211, R1s general chart notes did not contain written report regarding earlier wheelchair related injury. Based on interviews and record reviews that pertains to the left-heel blister observed on 08/28/2025, although the allegation that the facility did not provide written reports to responsible party of resident’s medical condition may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. No deficiencies were cited during today’s visit based on CCR Title 22. An exit interview was conducted with AED Valerie Baldugo and copy of the report was provided. page 3 of 3 end of report