Senior Care Records.

Facility Evaluation Report

Cicada - Brentwood, Brentwood06/02/2023Licence 079200108

Capacity6
Census6
Date signed06/02/2023 04:09:18 PM
The inspector’s account

On 06/02/23 around 01:00 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct a case management for a restricted healthcare condition request received on 12/14/22 around 10:35 PM by LPA L. Ibo for Client #1 (C1) . LPA met with Maria Reyes, Administrator (ADM), and explained the purpose of the visit.

LPA L. Holmes conducted a joint visit with Program Clinical Consult (PCC), Witnesses (W1, W2), toured the facility with PC, interviewed staff, reviewed records, and observed the compliancy of C1's gastrostomy care.

LPA requested the following documents be submitted to CCLD by 06/09/23: Documentation including, but not limited to C1's gastrostomy care, current physician's report, doctor's orders, appraisal and needs service plan/ISP, dietician referral, hospital discharge summary from 2016, Sutter home health records, staff members training records, and sign-in sheet for training attendees.

PCC determined that further review is needed.

Exit interview conducted and a copy of this report was provided to ADM.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction