Complaint Investigation Report

This licensing report supersedes the previous report dated 05/09/24. The reason it’s being superseded is to provide additional information not included on the original LIC9099 dated 05/09/24. The substantiated finding will remain the same.

On todays visit, LPA Vaid and LPM Fierros conducted a tour of the physical plant along with Administrator, Marilyn Acabal and obtained a copy of staff roster and client roster. Client #2 was present and all five clients were attending day program during the visit.

On 05/09/24, LPA Vaid interviewed client #2(C2) and was unable to interview clients #3- #6 (C3-C6) due the clients attending day programs. Staff #1-staff #2 (S1-S2) were interviewed. LPA Vaid and S#1 toured the physical plant and LPA observed how staff interacted with facility clients. LPA requested and obtained a copy of the staff schedule and client roster.

Regarding the allegation: Facility failed to submit an incident report to the proper agencies. It is alleged that the facility failed to submit an incident report to the Regional Center (RC) and Community Care Licensing (CCL) for incident that occurred on 05/17/2023 regarding C#1 being sent to emergency room. The facility administrator stated to have faxed the incident report to Regional Center via fax and to Community Care Licensing via fax, however, the administrator was unable to produce the fax confirmations. To date, community care licensing has not received the 05/17/2023 incident report. The 05/17/2023 incident report dated 05/18/2023 was received by Regional Center on 06/26/2023, which is late reporting. The investigation revealed, the facility failed to submit the unusual incident report to Licensing per Title 22 Reporting Requirements, regarding the incident that occurred on or around 05/17/2023, where C1 was sent to the emergency room. Additionally, administrator failed to notify C1 Regional Center of the incident in a timely manner.

Based on LPAs interviews which were conducted and records review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC 9099D.

Exit interview conducted with Administrator Marilyn Acabal, a copy of the licensing report and appeal rights were discussed and given at time of visit.