Facility Evaluation Report

On 4/1/2025 at approximately 10:15 a.m. Licensing Program Analysts (LPAs) Angelica Segovia and Huma Rahimi conducted an unannounced Case Management visit to this facility in conjunction with a complaint control #31-AS-20250324153245. LPAs met with the Executive Director (ED) Katherine Aleman and LPAs explained the reason for the visit.

During the visit, LPAs were informed that R2 had fallen in their room and were taken to the hospital. However, no incident report was submitted to the Community Care Licensing Department (CCLD). Upon record review, it was revealed that the facility failed to report the incident to the Regional Office (RO). In addition, the ED admitted that no incident report was submitted to the RO and that they were not aware they needed to report the incident. Based on Title 22 Regulation: a written Unusual Incident / Injury Report shall be submitted to CCLD within seven (7) days of occurrence. LPAs informed the ED that all staff members are mandated reporters and they are all responsible for reporting. LPAs reviewed all incident reports on CCLD's system and did not observe an Incident Report regarding R2. ED will submit Incident Report to CCLD for R2.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8 a deficiency was issued.

Exit interview conducted, appeal rights given, and a copy of this report was provided to the Executive Director .