Complaint Investigation Report

Staff indicated the alleged abuse happened on first week of May 2023; however, licensee submitted the UIR on 5/23/23 with incident date 5/06/23. Police report showed the alleged abuse was reported by third party not by the licensee and there’s no evidence that the licensee reported the alleged abuse to law enforcement.

R1 sustained bruises which were observed by R1’s family member (FM2) and witness (SS) on May 1 , 2023. W1 also confirmed observing the bruises which resulted from R1’s falling when being assisted in the bathroom. FM2 stated S2 informed him of the fall incident but S2 did not inform him of the bruises on R1’s chest area and shoulder. FM1 indicated he was informed by the facility staff about the fall incident which the Department confirmed with S2. Review of records and UIRs didn’t show the fall incident was reported to Community Care Licensing.

Based on information gathered, the preponderance of evidence has been met, therefore, the allegation is substantiated. Deficiency is cited from Title 22 California Code of Regulations and listed on 9099D. Failure to submit proof of correction by plan of correction due date and any repeat violation within 12-month period may result in civil penalty.

Deficiency and plan and proof of correction were discussed with licensee over the phone in the presence of ADM.

Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.