Complaint Investigation Report

submitted to CCLD, which indicated R1 had complained of pain to his arm to his family member on 3/18/2022, where R1 slid from his chair onto the floor. Per incident report R1 stated the incident occurred two weeks prior. R1 also stated at the time of the incident he refused help from the two (2) staff that came to assist. S1 stated during interview that protocol is for staff to inform the director of the incident in a timely manner.

Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted. A copy of the appeal rights and this report provided.