Complaint Investigation Report

The interview conducted with RP1 corroborated R1’s responsible party’s account of contacting R1’s responsible party at approximately one o’clock in the afternoon informing them of a fall R1 experienced. Interviews with Administrator reported that they contacted R1’s responsible party via text message on 5/28/2026 to inform R1’s responsible party of the fall incident and a FAX was provided to the CCL on 5/28/2026. A records review conducted of CCL’s Unusual Incident Reports confirmed that an incident report was not received for the incident dating 5/27/2026. LPA requested a copy of the FAX transmittal receipt. An interview conducted with the Administrator reports that the facility does not maintain copies of the FAX transmittal receipt to confirm if the FAX was successful received by CCL.

Therefore, the allegation of Licensee did not follow reporting requirements is deemed substantiated. A finding that the complaint is SUBSTANTIATED means that the allegation is valid as the preponderance of the evidence standard has been met. California Code of Regulations Title 22 is being cited on the attached LIC9099D.

An exit interview was conducted with Medication Technician Ligaya Carter and a copy of the LIC9099, LIC9099C, LIC9099D, and appeal rights will be provided to the Business Office Manager Nicole Anguiano.