Complaint Investigation Report

216804066-9-10-2024-21-AS-VBEI-D9ELUL-20240924090403

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 1450 NEOTOMAS AVENUE, STE. 100

This is an official report of an unannounced visit/investigation of a complaint received in our office on

07/11/2024 and conducted by Evaluator David Leibert

COMPLAINT CONTROL NUMBER: 21-AS-20240711152524

Facility failed to report incident(s) as required per regulation

Licensing Program Analyst Leibert arrived unannounced to deliver findings on this complaint. Complainant alleges R1 fell numerous times while in care and was sent out to emergency care on 4/22/2024 and that Responsible Person (RP) was not notified. The following determinations are based on documents reviewed and statements taken: Two incident report were obtained, dated 5/7 and 5/20/2024 indicating R1 fell and that the RP was notified; An E-mail chain was obtained, dated 5/14 and 5/17, 2024, between the RP and the prior Executive Director (ED); The E-mail chain documents the claim that R1 went out for emergency medical care on 4/22/204 and that the staff did not notify the Responsible Person; The prior ED apologized to the RP for the situation and indicated that additional training was given to the staff as a result. Based upon the documents reviewed, the preponderance of evidence standard has been met. Therefore, the complaint is SUBSTANTIATED. The following deficiencies were observed (see LIC 9099D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided. Report left.