Facility Evaluation Report

Licensing Program Analyst (LPA), Angela Panushkina, conducted a CASE MANAGEMENT visit at this facility to issue deficiency in conjunction with complaint control no.: 31-AS-20230605162033 and met with Amorlina Comedia, Staff #1 (S1). Administrator arrived shortly after and LPA explained the reason for the visit.

LPA conducted a physical plant walk through, at approximately 8:20 AM, to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22, Division 6. At 8:50 AM, LPA conducted an interview with one (1) staff members and two (2) out of four (4) residents. LPA also requested five (5) resident files, and three (3) staff files and obtained copies of pertinent documents relevant to the investigation. Upon review of documents LPA observed the following:

Incident occurred with R1 on 05/25/23 and an Incident Report (LIC624) was never submitted to the Community Care Licensing Department (CCLD) in a timely manner. Based on Title 22 Regulation: a written Unusual Incident / Injury Report shall be submitted to CCLD within seven (7) days of occurrence.

Facility is approved for one (1) hospice waiver and there are currently three (3) hospice residents

One (1) hospice resident has (3) 1/2 bed rail and one (1) non-hospice resident has full bed rail. LPA did not observe doctor orders on file for the bed rails.

A Staff #2 (S2) was hired to work today without having proper documentation and or fingerprints.

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 explained. Copy of this report signed and delivered.