Facility Evaluation Report

While at the facility investigating a complaint (Control # 15-AS-20251007084713) and upon review of resident's (R1) file, Licensing Program Analyst (LPA) Delmundo observed 3 Hospital Discharge Summaries showing R1 was seen in the hospital due to fall incidents that happened this October 2025. LPA interviewed Haidie Bautista, administrator (ADM), who stated she sent Unusual Incident Reports (UIRs). LPA checked the Department's e-faxed documents and facility's e-fax folder and didn't see UIRs for the said incidents. LPA also learned from ADM that local law enforcement came to the facility October 2, 2025 due to an alleged abuse, and LPA has not receive the SOC341 nor the UIR from the facility.

Deficiencies are cited from Title 22 California Code of Regulations and listed on 809Ds.

Deficiencies were discussed with the administrator, and informed that any repeat violations within 12 month period may result in civil penalty.

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