Facility Evaluation Report

At 10:15 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted unannounced visit to this facility in conjunction with a complaint control #31-AS-20250103082700. LPA met with the Wellness Director Nancy Ruiz and later the Executive Director (ED) arrived at the facility. LPA explained the reason for the visit.

During the visit, LPAs was informed that R1 was refusing to take his/her medication and other care services on multiple occasions. The facility staff did inform R1's Physician and family; however, no incident report was submitted to the Community Care Licensing Department (CCLD) in a timely manner. LPA reviewed all incident reports on a system and did not observe an Incident Report regarding R1. In addition, the ED and Wellness Director admitted that no incident was submitted to the Regional Office (RO). Based on Title 22 Regulation: a written Unusual Incident / Injury Report shall be submitted to CCLD within seven (7) days of occurrence. LPA informed ED that all staff members are mandated reporters and they are all responsible for reporting.

LPA informed ED to submit an incident report for all the medication or other care services refusal that occurred during R1's stay at the facility.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are cited and noted on LIC 809D.

Exit interview conducted, appeal rights and copy of report signed and delivered.