Facility Evaluation Report

On 05/22/2024, Licensing Program Analysts (LPAs) Evelin Rios and Lorena Casillas conducted unannounced visit to this facility in conjunction with a complaint control #31-AS-20240515150750. LPA met with Staff #1 (S1) who granted access to the facility. The Administrator met LPAs at 2:30 p.m and LPAs explained the reason for the visit.

During the visit, LPAs were informed that R1 had a difficulty breathing on 05/13/2024. 9-1-1 was called and R1 was taken to the hospital. 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 Administrator admitted that no incident report was submitted to the Regional Office (RO). LPA informed the Administrator to submit an incident report that occurred for the 05/13/2024 incident involving R1.

During the physical plant tour LPAs observed the following:

LPA's observed 3 cameras in common areas and one (1) camera in resident#3's (R3's) bedroom. According to Administrator they believe they included cameras in their plan of operation. Administrator could not provide the documentation at time of visit. According to administrator R3's family gave consent to have a camera in her room. According to administrator there is no sound and camera is live streaming only.

At 2:23 p.m. LPA Casillas observed a brick outside of the French doors leading to the backyard in bedroom labeled #3 meant to prevent the door from opening. According to Administrator the door does not stay closed and it has been like that for two weeks. According to staff it is used to prevent R2 from wondering.

Deficiencies are cited refer to 809D. Exit interview conducted, appeal rights and copy of report signed and delivered.