Complaint·November 28, 2023

Continued from 9099 On 10/30/2023, Staff #1 (S1) called R1's responsible party and  informed them of the incident that had occurred . Additionally , on 10/30, R1's responsible party visited R1 at the facility  and spoke with Staff #2 (S2)  and Staff #3 (S3) in person in regards to the incident. On 11/17/2023, the responsible party requested a detailed written report of the incident. S1, S2 and S3 verbally provided the responsible party with detailed information of the incident on 10/30, however a written report has not been provided to R1's responsible party as of 11/28/2023. Based on information gathered during the course of the investigation, the Department has sufficient evidence to support the allegation of Facility staff did not follow proper reporting requirements. Therefore, this allegation has been deemed Substantiated at this time. The following deficiencies were observed (See LIC 9099-D) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted appeal rights discussed and a copy of the report was provided to Administrator.