Complaint Investigation Report

requested by Resident 1 (R1) to assist with applying a suppository and ointment and that S1 complied with R1’s request. Facility submitted an incident report to Community Care Licensing (CCL) on 06/06/2025 detailing the incident.

Based on document review and observations made, this Allegation is Substantiated. A finding that the Complaint allegation is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Exit interview conducted. Copy of report, LIC9099D (Deficiency Page), Plan of Corrections, and Appeal Rights discussed and provided to Administrator. Signature on form confirms receipt of documents.