complaint·August 23, 2023

Continued LIC9099-C page 2 On 12/13/2022, LPA Pamela Bunker conducted the initial 10-day complaint investigation and conducted interviews from 2:00 p.m. to 3:30 p.m., along with reviewing and/or obtaining copies of the resident roster, staff roster, and insurance records. Facility staff stated that this facility had liability insurance with an effective date of 08/26/2022. Further investigation was required. Based on the investigation conducted by the Department it was determined that between 08/26/2022 and 12/06/2022, Licensee had liability insurance that did not include required coverage for resident’s injuries. As a result, the above-mentioned allegation is being substantiated. Please see LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative. Continued LIC9099-C page 2 Interviews conducted with facility staff and witnesses revealed that facility was actively working with multiple insurance agencies to finalize the policy to comply with Title 22 Regulations. Based on review of the policies submitted to the Department between 08/26/2022 and 12/06/2022 there is insufficient information to support the allegation(s) mentioned above. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.