Complaint·March 2, 2026

Allegation: Staff are not following proper reporting requirements It is alleged that the facility failed to comply with regulatory reporting requirements regarding incidents involving R1. During staff interviews (S1–S4), staff reported the following reporting procedures: Staff are required to report incidents directly to their supervisor and provide factual information regarding incidents that occur during their shifts. Staff complete Narrative Charting and an internal incident report form following an incident. These reports are submitted to the supervisor, who is responsible for submitting an Unusual Incident Report to Community Care Licensing (CCL). During the record review of documents provided by the facility, there were no Unusual Incident Reports on file regarding any incidents involving R1. The facility did provide Narrative Charting summaries dated January 27, 2026 (a.m. shift), in which two staff members documented that R1 may have fallen in her room and that R1 was observed the following day with a bruise to her right eye. An additional internal incident report dated January 28, 2026 (a.m. shift) documented that staff observed R1 with a black eye. Additionally, a Narrative Charting entry dated February 11, 2026, indicated that an altercation occurred between R1 and their roommate, during which R1 was reported to have hit their roommate. No Unusual Incident Reports were present in R1’s file, and the facility did not have records indicating that Unusual Incident Reports were completed for these incidents. Community Care Licensing also does not have records of ever receiving Unusual Incident Reports for either of these incidents. Based on LPA's interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED . California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC 9099D.