Facility Evaluation Report
On 10/14/2022 at 11:45AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a case management visit. LPA met with caregiver, Carlota Moises. Administrator, Aurelia Mendoza arrived about 30 minutes later.
During a complaint investigation (15-AS-20210610100816), LPA observed the following deficiency.
LPA observed facility did not submit incident report when R1 went to the hospital on 6/6/2021. Also, when R1 passed away on 6/26/2022, LPA did not receive death report for R1.
The deficiency was observed (see LIC 809D) and cited from the California Code of Regulations. Failure to correct deficiency by POC date may result in Civil Penalties.
Exit interview conducted. A copy of this report and appeal rights provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction