Facility Evaluation Report

On 06/05/25 at 2:38PM, LPA D Panllio conducted an unannounced case management visit to discuss the facility's COVID mitigation plan with administrator (ADM).

Prior to the 2PM visit, around 11:30AM, LPA spoke with ADM on the phone who confirmed that there were 2 residents that tested COVID positive on 05/08/25. All staff and residents were tested and results showed that on 05/16/25, 7 residents were COVID positive. Continuous rounds of COVID testings were done on 05/12/25, 05/16/25, 05/20/25. Last COVID testings done on 05/27/25 on all residents and staff showed only 1 resident still COVID positive. On 06/02/25, 1 staff tested COVID positive.

ADM stated all residents' activities were temporarily suspended and facility is on lock down due to COVID positive residents. ADM confirmed with LPA that no incident report (LIC624) was submitted to CCLD when the 2 residents first tested positive for COVID-19.

Deficiency is cited for violation of reporting requirements per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due dates and/or any repeat deficiencies within a 12-month period may result in civil penalties.

Exit interview conducted, appeal rights and copy of report provided.