Facility Evaluation Report
On 08/10/22, while at the facility for another reason, LPA observed staff failed to submit an incident report within 7 days of occurrence to CCL regarding resident’s (R1) fall on 07/13/22. LPA also observed staff failed to submit a death report (LIC624A) within 7 days of occurrence to CCL on resident’s (R1) demise that occurred at the facility on 07/18/22.
Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D.
Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties.
Exit interview conducted. Appeal Rights and a copy of this report provided via email.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction