Facility Evaluation Report

On 1/12/24, Licensing Program Analyst (LPA) M. Medina arrived at the facility to complete the required 10-day complaint visit and observed the following during facility tour and review of facility records:

Staff 1 (S1) and Staff (S2) are fingerprint cleared and not associated to facility but were observed working during facility visit.

Resident rooms for R2 and R3 contained half bed rails, Resident room for R4 contained full bed rails. Residents in these rooms are not on hospice or do not have a physician order with an exception from the department.

During interview with Licensee for complaint, facility was not able to show any record of incident report being sent to department for a fall on 12/24/23 for R1.

Based on today’s visit, deficiencies are being cited in accordance with Title 22 on the attached LIC 809D for the date of 1/12/2024. An immediate civil penalty is being assessed.

An exit interview was conducted with Licensee, Maria Emma Pangilinan, signed on site and a copy of this report, LIC 9098 Proof of Correction and Appeal rights were provided during visit.