Complaint Investigation Report

Previous to visit LPA obtained C1 pertinent file records, photos, and two incident reports.

On 09/29/2025, LPAs interviewed five (5) staff #1 - #5 and had interviewed C#2 on previous visit. C#1 moved and is unable to answer questions due to cognitive impairment. C#3 could not answer questions due to cognitive impairment.

Then investigation revealed: Allegation: Facility did not properly report incident to licensing agency.

There was an incident that occurred on 08/10/2025 at around 2:40 PM at home where C1 ran out the door, tripped and fell and hit face. Facility sent incident report to the department on 08/26/2025 which is 16 days after the incident. S4 stated S4 was told to send report and agreed that it was sent past the 7 days that is required by the department. There is sufficient evidence to substantiate this allegation.

Based on LPA's interviews and records reviewed, the preponderance of evidence standard has been met, therefore the allegation is found SUBSTANTIATED. California Code of Regulations Title 22, Division 6, and Chapter 1 & 6 are being cited on the attached LIC 9099D. Exit interview held and a copy of the report and appeal rights was provided.