Complaint Investigation Report

According to the interview with the administrator, C1's bruise observed by staff on 12/9/25 was not communicated to C1's representative due to a language barrier. The administrator informed the regional center and was not sure if the incident was relayed to the family on their behalf. Staff stated they normally contact C1’s family member to relay any information and to sign documents. Staff interviewed stated that when an incident arises, they would report it to the administrator or house manager, who then contacts the responsible parties to let them know what happened. Staff do not know if this particular incident was reported to C1’s authorized representative. Based on information gathered, this allegation is substantiated.

Allegation - Facility did not follow proper reporting requirements. It is alleged that the incident regarding Client #1’s injury was not reported to licensing. The administrator acknowledged that an incident report was not sent to CCL (Community Care Licensing) for the initial observation of the bruise on C1 but stated that a follow up status for C1’s fracture was submitted. According to record review, LPA did not receive an incident report from the facility regarding the initial bruise found on C1 on 12/9/25, however, a report was submitted to CCL and regional center on 12/14/25 for the collarbone fracture diagnosis. Since the facility did not submit the incident report for the initial observation of the bruising, the allegation is substantiated.

Based on interviews conducted and record review, the preponderance of evidence standard has been met, therefore, the above allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 and Chapters 1 and 6), are being cited on the attached LIC 9099D.

An exit interview was conducted. The Plan of Corrections were reviewed and developed with the administrator via telephone. A copy of this report and appeal rights were provided.