Complaint Investigation Report

one-to-one staff for C1 during the shift, assisted C1 to get cleaned up following the accident. After C1 was cleaned, S1 retrieved clean linen to change the bed, during which time, C1 reportedly fell sideways from the bed to the floor and hit his/her head during the fall. Records reviewed noted that C1 was assessed by the lead staff on the shift, who determined that C1 appeared to be fine, and the facility’s nurse was contacted via telephone and informed of the incident. Staff put C1 back in bed for the rest of the shift.

Based upon evidence received and reviewed during the investigation, C1 was required to have 1:1 arm’s length supervision at all times, and evidence indicates that C1 was not being supervised at the time of the fall.

Considering the foregoing, the allegation is substantiated. This finding means that the preponderance of the evidence standard has been met and the allegation is valid. Deficiency is cited in accordance with California Code of Regulations, Title 22, Division 6, Chapter 8 and noted on the attached LIC 9099-D.

An exit interview was conducted with Ali Jaouhar, and copies of this report and Licensee/Appeal Rights (LIC 9058) were provided at the conclusion of the visit. Ali's signature below serves as acknowledgment of receipt of copies of the report and rights.