Complaint Investigation Report

Allegation: Facility failed to meet reporting requirements.

The Department investigated the following allegation. Based on interview conducted with Administrator on 9/19/2024, interview revealed that there has been a few recent falls. R1 had a fall a day prior to LPAs' visit who then was sent out to the emergency room for evaluation. Interview revealed that R1's family member was notified but LIC 624 UNUSUAL INCIDENT/INJURY REPORT has not been submitted to Licensing yet. Interview with Administrator further revealed that R2 had a fall on 08/24/2024, where R2 had a nose bleed. Administrator contacted R2's responsible party and was asked to not send R2 out for evaluation. Administrator stated LIC 624 UNUSUAL INCIDENT/INJURY REPORT was not submitted to Licensing regrading this incident. Based on Title 22 Section 87211, facility is required to provide written report to Licensing Division within seven days of occurrence.

Based on the allegation, facility failed to meet reporting requirements , the allegation is SUBSTANTIATED - A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. The following allegation cited above is substantiated, please see LIC9099-D.

$250 repeated violation civil penalty assessed as facility was cited on 12/14/2023 for the same deficiency.

Exit interview conducted and a copy of the report and appeal rights was provided.