Complaint Investigation Report

The facility staff did not complete and submit an SOC341, suspected elder/adult abuse report as required by staff, as mandated reporters. There was sufficient information obtained to support the alleged violation occurred.

Per investigation, incident reported was reported to S1, facility staff, on 2/19/26, and the facility did not report to the Licensing agency until 3/9/26; Licensing Agency did not receive an SOC341 Suspected Elder/Adult Abuse report as required by law. Deficiency cited: W&I 15630(b)(1) Elderly and Dependent Adult Abuse Mandated Reporting Requirement.

Deficiency 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 with Supervisor Erica De Vera Appeal Rights provided with complaint report, LIC9099s.