Complaint Investigation Report

Relevant party reported that facility sent a resident (R1) to the hospital without notifying R1's authorized representative of the hospitalization in a timely manner.

During the investigation, LPA requested a written Unusual Incident Report (SIR) regarding R1's hospitalization from Administrator. LPA received an SIR regarding R1's hospitalization that was authored by Administrator on 12/7/2023 reporting that R1 was sent to the hospital on 11/24/2023.

Based on interviews conducted and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D page.

Exit interview was conducted with Administrator. A copy of this report and appeal rights were provided. Administrator's signature on these forms acknowledges receipt of these documents.