Facility Evaluation Report

Licensing Program Analysts (LPAs) Angela Panushkina and Perchui Milena Khurshudyan conducted unannounced visit to this facility in conjunction with a complaint control #31-AS-20240412163855. LPAs met with the Community Sales Director and explained the reason for the visit.

During the visit, LPAs conducted an interview with three (3) staff members and the Director of Nurses from hospice and were informed that at least twice R1 left the facility premises unassisted. These two (and or more) incidents, involving R1, took place between 03/24/24 to 04/13/24 and were not submitted to the Community Care Licensing Department (CCLD) in a timely manner. In addition, the Kristine Ellis 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. LPAs informed the Administrator that all staff members are mandated reporters and they are all responsible for reporting.

Exit interview conducted, appeal rights explained and copy of this report signed and delivered.