Facility Evaluation Report

On 2/22/2023 Licensing Program Analysts (LPAs) Evelin Rios and Melissa Spaeth conducted a case management deficiencies visit in conjunction to complaint control #31-AS-20230213132242.

At 9:10 a.m. during an interview with the Administrator, it was revealed a resident #1 (R1) had a bad day and shoved her. R1 was taken to the hospital for evaluation, R1's guardian was notified and a police report was completed. According to the administrator R1 was admitted to a hospital in San Bernardino County. LPAs asked administrator if an incident report was submitted to Community Care Licensing Division (CCLD) regional office. Administrator said, "no". At 9:27 a.m. LPAs conducted a physical plant tour of the facility to ensure the health and safety of the residents in care. At 9:47 a.m. while touring the kitchen LPAs observed food supply did not meet the required number of nonperishable food for a minimum of one week & perishable foods for a minimum of two days maintained on the premises. According to staff #1 (S1) who is responsible for food purchasing, they had a list of grocery items on their phone, they were going to purchase on today's date. S1 stated they were also going to make purchases at "Cotsco". At 9:58 a.m. LPA observed a large water spot on a ceiling tile in room 117. Upon further observation the tile was drooping to the point of almost falling down. Administrator stated they had not seen it there before. Resident #2 (R2) stated it was there when they moved in. R2 also stated it was not leaking. Administrator immediately notified maintenance to take care of it.

Deficiencies cited (refer to LIC 809-D). Civil Penalty assessed and penalty issued (See LIC 421FC). Exit interview conducted, Appeal Rights and a copy of this report provided.