Facility Evaluation Report

On 10/07/2025 at 1:30 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced to conduct a Case Management visit. LPA met with General Manager, Tianna Henderson and explained the purpose of the visit.

While conducting complaint investigation #15-AS-20241022215724, LPA L. Alexander observed during record review and interviews that an incident involving a 911 EMT response for Resident (R1) on 07/03/2023 was not reported to the Community Care Licensing Division (CCLD) as required. Staff (S1) stated they were unaware of the incident involving emergency medical services responding to R1. S1 confirmed that no LIC624 (Unusual Incident Report) was submitted to the Department. Based on information obtained, the facility failed to report an incident involving emergency medical response for a resident to the Department within the required timeframe.

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

An exit interview was conducted. A copy of this report and Appeal Rights (LIC9058) were provided to General Manager, Tianna Henderson.