Complaint Investigation Report

565850086-7-7-2022-29-AS-JAPL-CLFULF-20221123144036

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 21731 VENTURA BLVD. #250

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

06/07/2022 and conducted by Evaluator Teresa Camara

COMPLAINT CONTROL NUMBER: 29-AS-20220607132052

Incidents not being reported by facility administrator to licensing or regional center

Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint investigation visit regarding the above noted allegation. LPA was joined by Tri-Counties Regional Center Quality Assurance Specialists LIz Aced-Arnett. LPA met with Administrator Lorenzo Banas and explained the reason for the visit.

LPA conducted an interview with the Administrator regarding ongoing notes by staff and a prior interview with staff 3 (S3). S3 had documented Resident 1 (R1) had a behavioral episode on 05/17/2022 in which R1 was jumping (while seated) up and down on the bed. S3 was aware this episode caused bruising on R1's buttocks and leg but failed to document the injury. The Administrator failed to report the 05/17/2022 incident and was unaware of the bruising until it was reported to him by R1's family member. The Administrator did not report the 05/17/2022 incident and injury until 06/17/2022, therefore this allegation is deemed Substantiated at this time.

Pursuant to Title 22, California Code of Regulations, the following deficiencies are cited (see LIC 9099-D.). Exit interview conducted. A copy of the report and appeal rights were provided via email.