Facility Evaluation Report

Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct a case management in response to the Special Incident Report (SIR) and Death Report for resident (R1) submitted by the facility to the Department on 1/04/23. LPA met with Adelaide Castrence, licenseee, and informed the purpose of visit. LPA called and spoke with Aidan Castrence, administrator, over the phone.

SIR and Death Report indicated that R1 was sent out to the hospital on 11/12/22 and diagnosed with liver cancer. R1 was discharged back to the facility on 12/09/22 on hospice care. Reports further indicated that the facility has hospice waiver. However, hospice waiver was approved on previous license not on this current license. This was discussed with the licensee and administrator.

On this same day, 1/10/23, LPA reviewed R1's file, obtained copies of documents, and conducted interview. Review of records confirmed R1 was on hospice care which was also confirmed with staff when R1 passed away.

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 may result in civil penalty.

Deficiency and plan and proof of correction were discussed with administrator over the phone and with licensee.

Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided to the licensee.