Facility Evaluation Report

On 10/14/2025 at 12:00 pm, Licensing Program Analyst (LPA) Y. Brown conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 9/18/2025. LPA met with Dolly Rizvi, Administrator, and explained the purpose of the visit.

The incident occurred on 9/16/2025. Incident report stated that R1 became non responsive. R1 was previously being seen at the facility by Home Health due to unstageable wounds. LPA reviewed R1's care plan and interviewed S1. Although R1 was seen by home health professionals who cared for the wounds, licensee failed to obtain exception request and have it approved prior to retaining R1 back to the facility. The documents that were obtained showed that R1 had unstageable wounds on 8/27/2025 and stage 4 wounds on 9/3/2025, while still residing at the facility. The document obtained from the hospital stated that R1 was discharged on 9/17/2025. S1 stated that R1 was placed on hospice on 9/24/2025.

The deficiency was observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties.

Exit interview conducted. A copy of this report and appeal right provided.