Facility Evaluation Report

Licensing Program Analyst(s)(LPA) Mary Flores conducted a case management visit to give deficiencies related to a complaint investigation conducted on 11/09/21. LPA Flores met with Maria Quizon Administrator and explained the reason of the visit.

On 11/09/21 LPA Flores conducted a complaint investigation visit, during the investigation it was revealed facility did not ensure to safeguard confidentially within HIPPA law of resident #1's emergency packet documents during a transfer from facility to the hospital. Facility staff #1 provided paramedics emergency packet for resident #2 instead of resident #1. Hospital realized of the mistake upon contacting resident #2's responsible party. Responsible party arrived at the hospital and they were not able to identify resident #1 as a family member. Hospital contacted facility and requested the proper documents which were provided. This violates HIPPA law and confidentially requirements. In addition by providing the incorrect emergency packet documents facility did not ensure to safeguard the welfare of the resident.

Deficiencies are noted on LIC 809D per Title 22 Division 6 Chapter 8.

Exit interview was conducted with Maria Quizon administrator and a copy of this report, LIC 809D, and appeal rights were provided.