Facility Evaluation Report

Licensing Program Analyst (LPA) Sanjay Vaid and Licensing Program Manager (LPM) Fernando Fierros conducted a case management visit regarding deficiencies noted during visits conducted on 04/09/24 and 05/02/24. LPA Vaid met with lead staff, Joanne Hernandez, and spoke with Licensee Toby Miclat via telephone and discussed the purpose of the visit.

During 04/09/2024 visit, LPA Vaid interviewed Administrator and reviewed Resident #2 (R2) facility file. LPA obtained a copy of R2’s admission agreement, and any incident reports regarding R2.

Administrator reported R2 went on an outing with family for the period 04/13/23 through 04/16/2023 and R2 was expected to return to the facility on 04/16/2023. However, R2 did not return to the facility after the outing with family. On 04/15/2023, R2 was sent to the hospital for observation, while R2 was hospitalized, R2 passed away on 04/16/23 due to a medical issues. However, the facility failed to provide licensing with an incident report regarding R2s hospitalization and death. Per Administrator, R2 was never discharged from the facility. R2 was a resident of the facility when hospitalized on 04/15/2023 and on R2’s date of death.

Deficiencies cited per Title 22 Chapter 6 Division 8, Refer to attached LIC 809D.

Exit interview was conducted with caregiver, Joanne Hernandez. Licensing report and appeals rights were given.