Facility Evaluation Report

Licensing Program Analyst (LPA) conducted a Case Management - Deficiencies visit in conjunction with a complaint visit (Complaint Control #29-AS-20210715134128). LPA met with Benjie Binuya - Caregiver . Angelie De Leon - Resident Operation was contacted by phone and LPA explained the purpose of this report is to issue citation for deficiencies observed during the course of the complaint investigation.

During the complaint investigation of complaint #29-AS-20210715134128, Investigator Santana observed the following deficiencies:

1) Per review of the Licensing Information System (LIS) report, Staff #1 (S1) appears to be an uncleared adult. There was no record of anyone with this name among the facility’s personnel history. An immediate civil penalty is issued today for $500.

2) Resident #1 (R1) has half bedrails on bed, but it is unclear whether they are used solely for assistance with mobility, since they are engaged even when R1 sleeps.

3) Investigator Santana compared R1’s Appraisal Needs and Services Plan dated 05/10/2020 with the Plan dated 06/01/2021. It is evident the information from the former Plan was copied and applied to the latter Plan, rendering the 06/01/2021 Plan less than accurate. For example, the T7 compression fracture for which R1 was hospitalized sometime prior to 05/10/2020 would no longer be considered “recent” to 06/01/2021.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Immediate civil penalty $500 issued, exit interview conducted, copy of report and appeal rights issued via email to Licensee and Angelie De Leon - Resident Operation.