Complaint Investigation Report

Allegation: Facility failed to report a special incident per the requirement. It is alleged that staff did not submit an incident report to Community Care Licensing about C1 going to emergency room within the reporting requirements time frame. During interview with Administrator, it was revealed that C1 went in for a regular follow-up doctor appointment on 03/13/2026 but ended up at the emergency room. Administrator stated that the incident happened on a Friday and that it unintentionally slipped her mind. Administrator stated this was not any fault of my staff and she takes full accountability for not notifying Licensing until 03/18/2026. Per Administrator, she agrees with the CAP findings and will be complying with the CAP. Per CAP report and Administrator Marsha Haywood’s agreement, this corroborates this allegation.

Based on interviews conducted and document review, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. Deficiency is being cited according to California Code of Regulations, Title 22. Refer to LIC 9099D.

Exit interview conducted, appeal rights and this report was provided to Leticia Caro.