Admin.Special Incident Report (SIR)
Special Incident Reporting Procedures
SDRC Instructions: . The Special Incident Form is to be used by SDRC service providers and long-term care facilities. Please use this form when submitting SIRs to SDRC and Community Care Licensing.
CCL - San Diego Adult & Senior Care Regional Office
7575 Metropolitan Drive Suite 109 San Diego, CA 92108 Bus: (619) 767-2301 Fax: (619) 767-2252 E-mail: CCLASCPSanDiegoRO@dss.ca.gov Website: www.ccld.ca.gov Duty Officer of the Day: (619) 767-2320 - LIC624 Unusual Incident Injury Report- LIC 624A Death Report- LIC 624-LE Law Enforcement Contact
SDRC
4355 Ruffin Rd #200, San Diego CA 92123 Rachel J. Hefler, MA - Service Coordinator Bus: (760) 736-1220 Fax: (760) 736-1262E-mail: rachel.hefler@sdrc.orgWebsite: www.sdrc.org
Or ask for the on call service coordinator - SDRC Guidelines - SDRC SIR Form (2017)
Adult Protective Services
(800) 339-4661 (Web)
Local Law Enforcement
(760) 839-4722 (Web) Escondido Police DepT (760) 739-4722 (Web) Escondido Fire Dept Stn 7 (760) 740-3000 (Web) SD County Public Health
After taking appropriate emergency action, LICENSEE shall report events as listed below to the appropriate agency by telephone as soon as possible but not later than the listed time frames. The families of other LEGALLY AUTHORIZED REPRESENTATIVE of a minor or conservator of an adult will be notified as soon as possible. LICENSEE shall submit a written report within forty-eight (48) to CCL and SDRC explaining the circumstances.
1. Injuries/accidents/illnesses requiring medical attention or hospitalization
1. Unexplained absence
3. Fire/Explosion + Local Fire Authority
4. Encidents where residents caused injury to another
5. Incidents creating lawsuits or unfavorable publicity

6. Epidemics, catasrophes, poisoning, etc + Public Health
7. Suspected Abuse of neglect + Local Law Enforcement + Adult Protective Serivces
8. Death
PLEASE NOTE: If the incident occurs on a weekend or holiday and does not require action by the REGIONAL CENTER, notification may occur early on the next working day. Notification to CCL must be made during work hours.