Complaint Investigation Report

486801782-12-12-2023-21-AS-VBEI-CYMRUE-20231218121949

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 1450 NEOTOMAS AVENUE, STE. 100

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

12/01/2023 and conducted by Evaluator David Leibert

COMPLAINT CONTROL NUMBER: 21-AS-20231201140950

Staff did not notify responsible party of client injury sustained while in care.

Licensing Program Analyst Leibert arrives unannounced for the purpose of delivering findings on this complaint. C1 fell on or about 10/26/2023 and sustained injury which included fracture to 2 teeth and cut to lower lip which bleed. Staff applied first aid, notified the Administrator, and transported C1 home. Transportation staff notified C1's Responsible Person of the accident when C1 returned home. Responsible Person and Administrator spoke via phone about the incident approximately 1 and 1/2 hours after the accident. Facility's Plan of Operation requires a written notification be made within 24 hours to the Responsible Person if a client receives an injury while at Program. As of 12/01/2023, no written notification has been made by facility to Responsible Person. Based upon the documents and photographs reviewed, as well as statements from the Administrator and staff, the preponderance of evidence standard has been met. Therefore, the allegation is SUBSTANTIATED. The following deficiencies were observed (see LIC 9099D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.