Complaint Investigation Report

The investigation revealed the following:

Regarding: Failure to submit a Special Incident Report (SIR) for client within required

It's alleged that the facility did not provide Special Incident Reports (SIRs) to Community Care Licensing (CCL) in a timely manner.

Record review indicated that the facility sent SIR for incident which occurred on 11/29/2025. LPA confirmed that the department received the SIR on 12/9/2025. However, per interview with S1, the facility did not send the department SIR for C1’s hospitalization which occurred on 4/20/2025. Record review conducted by LPA further indicated that the facility did not send CCL the SIR until 3/20/2026. Interview with S1 further indicated that they did not report C1’s hospitalization because C1 was admitted only for observation and released the next day without needed treatment. Based on record review and interview with S1, the allegation that the facility did not provide SIR to CCL in a timely manner has been corroborated.

Based on interviews conducted, and records reviewed, 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 with Marilyn Acabal, Administrator, and a copy of this report was provided.