Complaint Investigation Report

The investigation revealed the following: regarding the allegation “Staff did not report incident to appropriate parties.” It is alleged that facility staff did not report an incident regarding R1 to R1’s responsible party. Record review of R1’s resident file revealed that R1 was admitted into the facility on 05/21/2026 and was receiving hospice care. Review of R1’s admission agreement revealed that R1’s family is the responsible party on record. Interview of S1 revealed that on 05/23/2026, around 7:40 am, R1’s vitals were dropping and S1 called S3 to inform them about R1’s vitals. Interview of S3 revealed that they called R1’s hospice team on 05/23/2026 at 7:45 am to advise them that R1’s vital were dropping and they needed to come see R1. S1, S2 and S3 revealed that they did not contact R1’responsible party to advise them that R1 had a change in condition. Interview of S3 revealed that they did not contact R1’s responsible party to advise them of R1’s change of condition around 7:40 am. Interview of W1 revealed that they contacted R1’s responsible party around 11am to update them on R1’s condition. Interview with W2 revealed that they treated R1 on 05/22/2026 at around 11pm and were allowed entry into the facility without issues. Three (3) out of the three (3) staff interviewed corroborated this allegation. Interview with witness#1 (W1) corroborated this allegation.

Based on LPAs record review and interviews conducted, 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 8 are cited on the attached LIC 9099D. Exit interview was conducted and a copy of this report, 9099-D and appeals rights were provided.