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32 | Identification and Emergency Information Form dated December 03, 2020 documents R1 as requiring the use of a walker or wheelchair to ambulate. It also documents R1’s daughter-in-law. On December 17, 2022, R1 was found laying on their bedroom floor by Caregiver 1 (C1) after responding to a noise coming from R1’s bedroom. R1 reported they were trying to reach for a mirror in the night stand when their knee gave out, causing them to fall. C1 called Administrator Carmen Achim who is reported to live five minutes away. Upon arrival and finding R1 in pain, 9-1-1 was contacted. R1 was admitted to Hoag Hospital Newport Beach where they were admitted with a diagnosed fracture of right pubis and displaced fracture of anterior column (iliopubic) of right acetabulum. R1 was assessed by hospital staff to require a skilled nursing facility. Per Huntington Beach Fire Department 911 response records and documentation, response to R1’s fall occurred on December 17, 2022 at 6:42 PM at Huntington Elder Care home facility. Huntington Beach Fire Department scanned into records the documentation provided to them by Huntington Elder Care home which included R1’s insurance cards, medication lists and dosages, and R1’s identification and emergency information form. Per interview with facility staff, three of five staff interviewed denied any neglect occurred. The two remaining staff reported they were not present when the fall occurred. Interviews with three of three staff present during the time of the incident reported there was confusion over who was going to notify R1’s responsible party of the fall, which caused a delay in notification; However, once realized, R1’s responsible party was informed of R1’s hospitalization within 24 hours of fall occurring.
Medical records obtained from hospital notate that R1’s family was contacted by the hospital social worker and no concerns of neglect were expressed. Documentation obtained from Administrator Achim included emails and text messages from R1’s responsible party in which they acknowledge an understanding that R1 is a fall risk and know they will have falls. It was further expressed that they felt “Your caregivers have been great…”
Based on interviews conducted and records reviewed, the allegations that facility lacked care and supervision resulting in resident sustaining a fracture; staff failed to provide residents medical information to paramedics; and staff did not inform authorized representative of incident in a timely manner are deemed to be Unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred.
An exit interview was conducted and a copy of this report and confidential names list was provided to Administrator.
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