Complaint Investigation Report

331881421-8-8-2025-18-AS-APEZ-DKKR52-20250815124221

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

RIVERSIDE ASC , 1650 SPRUCE ST STE 200 MS29-27

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

08/26/2024 and conducted by Evaluator Abdoulaye Zerbo

COMPLAINT CONTROL NUMBER: 18-AS-20240826183736

Staff did not report an incident involving resident in care as required.

Licensing Program Analyst (LPA) Abdoulaye Zerbo conducted an unannounced visit to deliver findings on the allegation listed above. LPA Abdoulaye was greeted and granted entrance by staff Veronica Jackson. LPA identified himself and discussed the purpose of the visit.

It was alleged staff did not report an incident involving a resident in care as required. LPA conducted an interview with the licensee who confirmed they did not report an incident occurring on 07/31/2024, involving Resident 1 (R1), to the Long Term Care Ombudsman (LTCO) within the time frame required by law. A review of the Unusual Incident/Injury Report dated 08/01/2024 revealed the LTCO was notified on 08/19/2024. This corroborates the time frame required by law was not met.

Based on interviews and records review, the allegation that staff did not report an incident involving a resident as required was determined to be substantiated. A substantiated finding means the allegation is valid because the preponderance of the evidence standard has been met. Pursuant to the California Code of Regulations, Title 22, Division 6, Health and Safety Code, a deficiency is cited on the attached LIC 9099-D.

An exit interview was conducted where this report, LIC9099D and appeal rights were discussed and provided to Administrator Ma Satchel Lecita.