Facility Evaluation Report
On 01/07/2025, The Department conducted an unannounced visit to deliver findings for the alleged allegations for complaint Control Number 11-AS-20251223093452 . LPA met with Catherine Dacara (Assistant Administrator) as the purpose of the visit was explained.
On 01/07/2025 between the hours of 8:30am - 8:45am, LPA conducted a records review and observed the following: the department did not receive a LIC 625: Serious/Unusual Incident Report in regard to Resident 10 (R10) having an unwitnessed fall and being sent out to the hospital on 12/09/2025.
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 Catherine Dacara (Assistant Administrator) , appeal rights explained, and a copy of this report was provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction