Facility Evaluation Report
On 11/05/2025 at 8:25am, Licensing Program Analysts (LPA) Zina Brown conducted an unannounced visit to deliver findings for the alleged allegations for complaint Control Number 11-AS-20251006160920 . LPA met with Joel Niblett (Administrator) who was informed of the purpose of the visit.
On 11/05/2025 between the hours of 8:25am -8:45am, LPA conducted a records review and observed the following: The facility did not submit a LIC 624 Unusual Incident/Injury Report in regards to Resident 1 being transported to Long Beach Memorial Hospital on 09/27/2025 nor a LIC 624A Death Report in regards to Resident 1 passing away at the hospital on 09/30/2025.
The facility failed to report the incident as required to the department.
Deficiency cited under California Code of Regulation Title 22 Division 6 Chapter 8 are being cited on the attached LIC 809-D.
Exit interview conducted with Joel Niblett (Administrator) and copy of this report was provided with appeal rights.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction