Complaint·June 2, 2023

Continued from LIC9099 On 5/10/23, SRPD Detective verified results came back and it matched the DNA found on R1. S2 was arrested that morning, 5/10/23, and was booked into Marin County jail on two felonies. S2 was fingerprint cleared to work at the facility, training on facility policies and procedures including personal rights. S2 violated the rights of R1. This allegation is Substantiated . There is an allegation of Neglect/Lack of Supervision - Facility failed to seek timely medical attention for resident in care . On September 4, 2022, S1 observed S2 in R1’s bathroom at approximately 1300-1330 hours. Staff working the Sunday shift did not know who to report the incident to. S1 contacted another caregiver Staff Member 3 (S3) who also reported the incident to the Activity Assistant, Staff Member 4 (S4). When S4 returned home at approximately 1700 hours, they contacted Management to report the incident. At approximately 1900-1930 hours Resident Care Coordinator and RN arrived to the facility to do a visual check of R1. The Facility Administrator contacted SRPD and Resident's family between 1800-2100 hours. R1 was not taken to the hospital until the next morning. SRPD responded to the facility the next day. Based on the suspicious nature of the incident staff failed to contact the police and ensure resident was seen timely in the ER. This allegation is Substantiated . There is an allegation of Reporting Requirement - facility failed to report incident timely per regulations . On September 4, 2022, S1 observed S2 in R1’s bathroom at approximately 1300-1330 hours. Staff working the Sunday shift did not know who to report the incident to, staff on shift did not contact the Police based on the suspicious nature of the incident. Instead, S1 contacted another caregiver, S3, who reported the incident to S4. When S4 returned home at approximately 1700 hours, they contacted Management to report the incident. At approximately 1900-1930 hours Resident Care Coordinator and RN arrived at the facility to do a visual check of R1. The Facility Administrator contacted SRPD and Resident's family between 1800-2100 hours. R1 was not taken to the hospital until the next morning. SRPD responded to the facility the next day. Facility failed to follow the mandated reporting requirement timeframes per W&I Code 15630(b)(1). This allegation Substantiated . Continued on LIC9099C Continued from LIC9099C The issuance of a Civil Penalty is under review. The Licensee is being informed that a Civil Penalty might be assessed based on a violation that the department determines constitutes physical abuse, as defined in Section 15610.63 of the Welfare and Institutions Code, or resulted in serious bodily injury, as defined in Section 15610.67 of the Welfare and Institutions Code, to a resident. The Regional Office will be inviting the Licensee to attend a Non-Compliance Conference, date to be determined. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. Exit interview conducted. Copy of report, LIC 811 (Confidential Names), LIC-9099D (Deficiency Page), Plan of Corrections, and Appeal Rights discussed and provided to Administrator. Signature on form confirms receipt of documents.