complaint·April 16, 2021

Continued from 9099. Based on record review and interviews R1 engaged in an incident of behaviors including agitation and threatening harm to themselves and others while in the facility. Staff one (S1) contacted Behavioral Health Services Crisis who based on the assessment of R1's behavior instructed S1 to request local law enforcement's assistance to provide R1 transportation to hospital for evaluation. Interview with Crisis stated the standard operating procedure would be to recommend that emergency medical services are called transport for anyone who is agitated or threatening harm to themselves or others. When local law enforcement officers arrived, S1 was was observed calmed. Interviews stated R1's history of calming down upon emergency medical personnel arrival during episodes of behaviors. S1 again contacted Crisis and was advised to follow p rocedures in that R1 be provided transport to hospital by emergency services. R1 was provided transport for to hospital by ambulance. S1 stated there have been other instances wher e facility staff provided R1 transport when R1 was not threatening harm but requesting Crisis evaluation and they follow Crisis's recommendations for when to contact emergency services for resident transport to hospital evaluation. It was determined in the course of the investigation based on the information provided through documentation and interview, the allegations of facility failed to assist resident with appropriate transportation are unfounded. This agency has investigated the complaint alleging facility failed to assist resident with appropriate transportation. We have found the allegations false. No deficiencies were cited. An exit interview was conducted. A copy of this report was provided to via email, due to COVID-19 precautionary measures, with a "read receipt" to verify the 9099 and appeal rights were received. The licensee is print out the report and fax a signed copy to LPA at 916-263-4744 or email to LPA at ashley.boothe@dss.ca.gov Continued from 9099A. Based on record review and interviews R1 engaged in an incident of behaviors including agitation and threatening harm to themselves and others while in the facility. Staff one (S1) contacted San Joaquin Behavioral Health Services Crisis hotline who based on the assessment of R1's behavior instructed S1 to request local law enforcement's assistance to provide R1 transportation to hospital for evaluation. R1 was provided emergency medical transportation to hospital by ambulance. LPA observed the record of the LIC624 was documented by Licensee the following day but here is no record of the report on file with the Regional Office. The Licensee stated it was faxed from their home fax machine which was old and did not provide confirmation of transmission receipt. LPA reviewed facility fax files and there are no incident reports for R1’s behaviors submitted to the RO recording incidents staff stated increased frequency after R1's medication change that fall under required reporting requirement to be submitted to the RO. The licensee emailed LPA LIC624 16 days after the incident occurred upon LPA request. It was determined in the course of the investigation based on the information provided through documentation, the allegations of facility failure to report were substantiated meaning that there was a preponderance of evidence to prove that the allegations occurred as reported. The preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. The following deficiencies were cited on 9099-D per Title 22, Division 6 of the California Code of Regulations. Failure to correct the deficiencies may result in civil penalties. An exit interview was conducted. A copy of this report was provided to via email, due to COVID-19 precautionary measures, with a "read receipt" to verify the LIC 9099, LIC 9099-D and appeal rights were received. The Licensee is print out the report and fax a signed copy to LPA at 916-263-4744 or email to LPA at ashley.boothe@dss.ca.gov