Facility Evaluation Report

On 06/15/23, while at the facility for another reason, Licensing Program Analyst (LPA) observed resident’s (R1) written documents (pre-appraisal report, admission agreement, physician’s report, needs & services plan, ID and emergency information) were not available for inspection at the facility. ADM stated R1 called 911 herself on 4/09/23 and was taken to ER hospital by ambulance. Staff gave paramedics R1's folder of documents containing her admission agreement, pre-appraisal/ appraisal reports, physician's report, incident reports, needs and services plan. ADM stated he was not able to locate R1’s missing folder at the hospital.

Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D. Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties .

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