Facility Evaluation Report

During the course of investigation of a complaint ( 15-AS-20230608092900 ), Licensing Program Analyst (LPA) L. Fici learned that resident (R1) sustained a fall on 10/16/2022, 12/20/2022, and 5/9/2023. Review of records revealed the facility did not submit incident reports to CCL on a timely manner.

LPA discussed with Gigi Tamayo, RN, Emily Poon, Administrator, and Angel Lee, Director of operations, the above incidents, and Title 22 Reporting Requirement.

Deficiency is cited from Title 22 California Code of Regulations and listed on 809D. Failure to submit proof of correction by plan of correction due date, and any repeat violation within 12-month period may result in civil penalty.

Exit interview conducted with RN, and a copy of this report given along with appeal rights.