Facility Evaluation Report

Licensing Program Analyst (LPA) Martha Arroyo conducted a Case Management - Deficiencies visit in conjunction with a complaint visit (Complaint Control # 29-AS-20230309110540). The purpose of the visit is to issue a citation for a deficiency observed during the complaint investigation.

During the complaint investigation of complaint # 29-AS-20230309110540, the following deficiency was observed: On 02/27/2023, Resident #1 (R1) suffered an unwitnessed fall in the middle of the night which resulted in R1 suffering from a subdermal hematoma and subarachnoid hemorrhage. Staff dialed 9-1-1 and called for an ambulance as R1 was observed on the floor with blood on their head. R1 was ultimately taken out of the facility and hospitalized due to the fall. Record review and interviews conducted revealed that neither incident was reported to Community Care Licensing (CCL) or the serious incident/injury report (LIC 624) was submitted to CCL within seven (7) days of occurrence as required by the California Code of Regulations.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D).

Exit Interview. Citation issued. A copy of the report and appeal rights were issued to the Administrator.