Facility Evaluation Report

Licensing Program Analyst (LPA) Huma Rahimi conducted unannounced visit to this facility in conjunction with a complaint control #31-AS-20250314081909. LPA met with Carlos Lara, Executive Director and explained reason for the visit.

During the visit, LPA conducted file review of R1 and observed that R1 is diagnosed with Mild Cognitive Impairment and Fibromyalgia (impaired balance and muscle weakness) as of 05/23/2023; however, no new Physician report was obtained or updated for any changes of Cognitive Impairment or Fibromyalgia. Furthermore, the facility did not notify R1's Physician nor updated the Appraisal Needs and Service Plan for R1 to meet their needs. LPA observed that the Appraisal Needs and Services Plan was last updated on 10/14/2020.

Moreover, LPA was informed that R1 was transported to hospital for Acute UTI, Intertrigo, and multiple falls on 03/11/2025; 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 Executive 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 the Administrator that all staff members are mandated reporters and they are all responsible for reporting.

LPA informed the Executive Director to submit an incident report that occurred on:

Deficiencies are cited and noted on LIC 809D. Exit interview conducted, appeal rights and copy of report signed and delivered.