complaint·July 28, 2023

***This report supersedes report dated 7/7/23 to correct verbiage in the substantiated statement. No further investigation was conducted or changes to the findings made *** The investigation revealed the following: Regarding allegation - Facility failed to meet reporting requirements. It is alleged no written reports were provided to resident or responsible party for the following dates: January (unknown date) 2020 and 2021, 10/02/21, 05/12/22, 07/01/22, 07/02/22, 07/12/22. Interview with R1 revealed facility provided copies of most incident reports. However, facility did not provide an incident report for the following incidents: January 2020 to report positive cases for COVID 19. January 2021 to report bed bugs in resident’s room. Administrator submits incident reports to the department and it is not aware of the reason facility failed to submit incident report for incident on 7/14/22. Administrator was not employ with the facility at that time. During file review, LPA observed facility provided R1 and R1’s representatives a copy of R1’s file on 11/23/22 containing letter of response, billing records, and health record. Health notes kept by the facility were provided on 11/23/22 for the following dates: 10/2/21 6/28/22,7/24/22,7/26/22, 7/29/22,7/31/22. Facility did not submit incident reports to report any COVID cases in January 2020 because there were no positive cases. Facility did not submit any incident reports in the month of January 2021 related to bed bugs because there was no proof the facility had bed bugs. LPA reviewed pest control invoices and discovered the company treated room #229, but there was no documentation that the room had bed bugs. LPA reviewed incident reports submitted to the department and discovered no incident reports were submitted to the department for 5/12/22, 7/2/22 or 7/14/22. Facility provided copies of incident reports to LPA during the initial complaint investigation visit conducted on 5/18/23 for incidents on 7/2/22 and 7/14/22. A transmission copy for incident on 7/2/22 was provided to LPA during today's visit to confirm incident was faxed to the department. Facility failed to report incidents occurred on 7/14/22 to the department and failed to provide written notification to R1 and responsible party. There are no records to indicate an incident occurred on 5/12/22. Based on LPAs interviews which were conducted and records 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 8 are being cited on the attached LIC 9099D. Exit interview was conducted and a copy of this report was provided. Appeal rights provided and discussed