Complaint Investigation Report

502700257-10-27-2021-27-AS-KHOS-C8EPAD-20211103110835

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 2525 NATOMAS PARK DR. STE.270

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

09/21/2021 and conducted by Evaluator Arlene D Garcia

COMPLAINT CONTROL NUMBER: 27-AS-20210921102551

Staff did not properly report an incident involving a client while in care.

Licensing Program Analyst (LPA) Arlene Garcia made an unannounced visit to Skye Residential for the purpose of delivering the findings of the above allegation. LPA was greeted by Lillie King, Caregiver S1. LPA met with Derek King, Admiinistrator (AD) and advised the purpose of LPA's visit.

The initial 10 day Visit was conducted on 9/24/2021.

It was alleged that staff did not properly report an incident involving a client while in care.

During the course of the investigation, LPA interviewed staff. LPA toured facility. LPA reviewed resident and facility records. Records reviewed R1 was treated by a physician via telehealth and mobile xrays were conducted. AD confirmed the incident occurred on 6/23/21 and that AD did not know it needed to be reported to CCLD. AD stated AD was not aware incident needed to be reported as R1 did not sustain any fractures and had no change in medical condition.

Based on interviews and records reviewed, the allegation that staff did not properly report an incident involving a client while in care has been deemed SUBSTANTIATED.

This agency has investigated the allegation notice and has found the allegation to be substantiated meaning that there was a preponderance of evidence to prove the allegation was true as reported.

The following deficiency was cited per Title 22 Provision 6 of the CA Code of Regulations. An exit interview was conduct. A copy of this report along with appeal rights was provided via email.