Facility Evaluation Report

During the course of investigation of a complaint (Control # 15-AS-20240229112553), and upon review of incident reports submitted by the facility to the Department, Licensing Program Analyst (LPA) Delmundo learned that the facility did not submit Unusual Incident Report (UIR) for the incident that happened in February 2024 when resident (R1) was able to access the medication room which was unlocked at that time.

The above incident was discussed by LPA with Administrator Clearnise Bullard and Regional Director Michelle Mayberry-Porter.

Deficiency is cited from Title 22 Calofornia 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 penalties.

Deficiency and plan and proof of correction were discussed with the Administrator and Regional Director,

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