Complaint Investigation Report

Regarding: Staff did not perform an assessment on a client in care.

It is alleged that client was not assessed by their doctor before admission to the facility nor during the period client lived in the facility.

Interview with S1 revealed that P1 was not seen by a doctor for a medical assessment prior to being admitted to live in the home in July 2025. S1 also indicated that P1 was not assessed by their doctor during the period P1 lived in the facility from July 2025 to January 2026. During the time P1 lived in the facility, S1 did not schedule an appointment to have P1 assessed by their doctor. S1 indicated that the Case Management agency that provides services to clients in care was supposed to assist P1 by making an appointment with their medical doctor for an assessment to be completed; however, S1 indicated that the Case Management agency did not follow-up with making the appointment and S1 did not follow-up either. Review of client records revealed that (9) clients do not have a Physician’s Report on file. S1 indicated that the (9) clients have not received a medical assessment for more than a year. Interviews and record review corroborate the allegation that staff did not perform an assessment on a client in care.

The preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated . California Code of Regulations (Title 22), is being cited on the attached LIC 9099 D. An exit interview was conducted, and a copy of this report was provided.