STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING
SEE REVERSE FOR INSTRUCTIONS AND DEFINITIONS
COMPLAINT CONTROL LOG
CONTROL
NUMBER
FACILITY NAME
FACILITY
NUMBER
COMPLAINT
CODE*
DATE
RECEIVED
INVESTIGATOR
/
EVALUATOR
NUMBER
DATE
TO
RIS/AS
DATE
VISIT
DUE
DATE
VISIT
MADE
RESOLUTION
REQUIRES FURTHER
INVESTIGATION
DATE
RESOLVED/
CLOSED
S I U
*Complaint Code Numbers (See reverse for explanation)
1. Physical Abuse/Corporal Punishment
2. Sexual Abuse
3. Personal Rights
4. Unlicensed Care
5. Fire Clearance
6. Crimes
7 Physical Plant
8 Record Keeping
9. License
10. Neglect/Lack of Supervision
11. Food Service
12. False Statements
13. Medication
14. Financial Abuse
15. Level of Care
16. Qualifications
17. Financial Issues
18. Questionable Death
LIC 957 (10/99)) PUBLIC
Complaint Control Log Instructions - The purpose of the Complaint Log is to track complaints received in the District Office to assure that the complaints have been handled in a timely
manner. When a complaint is received in the district and the Complaint Report (LIC 802) completed, the complaint must be entered into the Complaint Log, assigned a Control Number and
a visit made within 10 calendar days from the date the complaint was received. For complaints with multiple allegations, each element of the complaint must be logged on a separate line.
Similar allegations are listed under the same Complaint Code, i.e. unsanitary building, inappropriate temperatures and no phones are all listed under Code 07 (Physical Plant). Complaints
received with multiple allegations are logged under the same Control Number and with the appropriate Complaint Codes as defined below. The Investigator/Evaluator Number is the
computer code given to the caseload or the Investigator’s badge number if the complaint is referred to the Regional Investigations Section (RIS) and/or Audit Section (AS).
Resolution - When the investigation ends, check the proper resolution code. The Resolution Codes are (S) Substantiated, (I) Inconclusive or (U) Unfounded. A complaint allegation is
substantiated if the allegation is determined to be valid and the facility cited. A complaint allegation is inconclusive if it may have happened but cannot be proven. A complaint allegation
which is unfounded is determined to be false or found to be without reasonable basis. If resolution cannot be reached within 30 days after the initial visit, check “Requires Further
Investigation”. Complaints requiring further investigation do not need to be re-entered on the Complaint Control Log. Enter the date the complaint was reviewed and approved by the
Supervisor as “Date Resolved/Closed”.
Complaint Code Definitions:
01. PHYSICAL ABUSE/CORPORAL PUNISHMENT - Conduct causing client physical pain or injury including slapping, spanking, hitting, squeezing or an unexplained client injury.
02. SEXUAL ABUSE - Inappropriate sexual activity between a client and non-client including rape, molestation, sodomy, voyeurism, pornography, or sexual harassment.
03. PERSONAL RIGHTS - Verbal or emotional abuse, intimidation, interference with daily living such as eating or sleeping, locking clients in or out or using other restraints.
04. UNLICENSED CARE - Providing care/supervision or accepting clients in need of care/supervision without a license.
05. FIRE CLEARANCE - Operating a facility in violation of the fire clearance or without a required clearance.
06. CRIMES - A criminal conviction or charges of a crime whether or not resulting in an arrest or conviction.
07. PHYSICAL PLANT - Unsafe or unsanitary buildings or grounds including unfenced pool, poor repair, heating, lighting, cooling or lack of phone or signal system.
08. RECORD KEEPING - Inadequate client or staff records including medical, staff qualification, admission agreement, or other required records.
09. LICENSE - Operating beyond the terms of the license, including overcapacity. Excludes“level of care”.
10. NEGLECT/LACK OF SUPERVISION - Lack of adequate staff to provide aid with daily living including dressing, bathing, feeding, transportation, or medical needs. Failure to protect
clients from harm.
11. FOOD SERVICE - Failure to provide adequate food service including poor food, special diets, menu planning, etc.
12. FALSE STATEMENTS - Providing false information such as on the application, lying about facility incidents or submitting false reports about the clients.
13. MEDICATION - Mishandling of medications including poor storage, dispensing, labeling or recordkeeping.
14. FINANCIAL ABUSE - Misuse of client cash resources such as P & I, gifts, SSI/SSP checks or failure to protect client’s personal property.
15. LEVEL OF CARE - Accepting/retaining clients requiring a higher level of care than allowed in a non-medical facility or by the license.
16. QUALIFICATIONS - Persons providing services not meeting the required qualifications.
17. FINANCIAL ISSUES - Lack of resources to operate the facility within licensing requirements or other non-client financial issues.
18. QUESTIONABLE DEATH - Client’s death where it appears the facility could be responsible or have done more to prevent the death.
19. OTHER - All violations which do not fit into one of the categories above.