Facility Evaluation Report

On 12/12/24 around 10:40 AM L. Holmes, Licensing Program Analyst (LPA) arrived unannounced to conduct a case management for complaint #15-AS-20240716140724 received on 07/16/2024. LPA Jesus Gonzalez, Executive Director (ED) and explained the purpose of the visit.

During the investigation of the above complaint, LPA interviewed ED, Staff (S1, S2, S3, S4, S5) Witnesses (W1, W2, W3, W4), obtained a resident roster, and requested the following for Resident #1 (R1): current Physician's Report, Admission Agreement, ID/Emergency Contact information, hospice care plan, care notes, incident reports, hospice notification, facility's regulations and documentation regarding Stage 3 and 4 pressure wounds, emails and/or written communications to R1's family regarding pressure wound injuries.

-On 07/23/24, LPA requested R1’s Initiation of Hospice notification and Physician’s Report (LIC602) from S1. LPA requested the reports be provided to the Community Care Licensing Department (CCLD) by 07/30/2024 for preliminary review. The records weren’t provided to LPA during the investigation.

-On 07/23/24, LPA requested R1’s Unusual Incident Reports (UIRs) from S1. R1 was transported to Alta Bates Medical Center in Berkeley for emergency services to treat a stage 3 to 4 pressure wound. Notification of deviation of R1’s hospice care plan on 07/14/24 was not provided to CCLD.