Facility Evaluation Report
Licensing Program Analyst (LPA) Huma Rahimi conducted unannounced visit to this facility in conjunction with a complaint control # 31-AS-20240521090631. LPA met with Staff #1 (S1) who granted access to facility. The Administrator was contacted and shortly after, the Administrator arrived and LPA explained the reason for the visit.
During the visit, LPA was informed that R1 had GI bleed due to ischemic colitis on 05/11/2024. 9-1-1 was called and R1 was taken to the hospital. However, no incident report was submitted to the Community Care Licensing Department (CCLD) in a timely manner. LPA reviewed all incident reports on a system and did not observe an Incident Report regarding R1. In addition, the Administrator admitted that no incident was submitted to the Regional Office (RO). Based on Title 22 Regulation: a written Unusual Incident / Injury Report shall be submitted to CCLD within seven (7) days of occurrence. LPA informed the Administrator that all staff members are mandated reporters and they are all responsible for reporting.
LPA informed the Administrator to submit two incident reports that occurred on:
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction