Facility Evaluation Report

During the investigation of a complaint (Control # 15-AS-20210115122146) and upon review of resident's (R1) records, Licensing Program Analyst (LPA) Delmundo learned that R1 was admitted to the facility with stage 3 pressure injury, The licensee did not submit an exception request.

Deficiency is cited from Title 22 California Code of Regulations and listed on 9099D . Failure to submit proof of correction by plan of correction due date and any repeat violation within 12 month period may result in civil penalty.

Deficiency and plan and proof of correction were discussed with Lilia Perdiguerra.

Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.