Facility Evaluation Report

On 05/15/2024 at 3:00 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct a case management visit. LPA met with Caregiver, Rosario "Chary" Mababa and explained the purpose for the visit.

While LPA L. Alexander was at the facility for a Plan of Correction (POC) visit and the following deficiencies was observed.

Client (C1) records were not available for review. LPA was informed that C1 has home health services and was hospitalized on 04/04/2024. This particular incident was not reported to CCLD. In addition, LPA was informed that C1 needs oxygen 24/7 and is unable to take the portable oxygen off it's charger unless someone else is there to remove the portable oxygen. C1 has an oxygen concentrator in his bedroom. At this time of the visit it is unclear if C1 has the ability to manage his oxygen on his own without assistance from staff. The Administrator was not available during the visit.

Documents obtained by LPA: C1's Hospital After Visit Summary (dated 04/05/24), Physician's Report (LIC 602 dated 10/30/19), Appraisal Needs and Services (dated 04/01/19) and RCEB IPP Addendum (dated 02/20/24).

The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties.

Exit interview conducted. Appeal Rights and a copy of this report provided.