Facility Evaluation Report
On 08/04/2026, at 12:30pm, Licensing Program Analyst (LPA) Zina Brown conducted a Case Management for complaint Control Number 11-AS-20251217122530. LPA met with Robert Jakini, Administrator, as the purpose of the visit was explained.
LPA reviewed the facility’s reporting history and progress notes related to R1’s documented falls and observed the following:
On October 30, 2025, R1 sustained a fall resulting in a quarter-size hematoma above the right eye; EMS and family were notified.
On November 8, 2025, R1 fell out of bed and sustained a hematoma to the back of the head and was transported to St. Mary’s.
On December 14, 2025, R1 sustained an unwitnessed fall at 0515 hours and was assisted back to bed.
On December 15, 2025, R1 sustained an unwitnessed fall in the bathroom, complained of head pain, and was transported to the hospital where an intracranial hemorrhage was identified.
The Department received the incident reports for the falls dated November 08, 2025 & December 15, 2025.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction