Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Case Management Deficiencies in conjunction with a complaint visit (Complaint Control #28-AS-20250324101021). The purpose of this visit is to issue deficiency that was not part of the complaint allegation.

During the investigation of Investigator Hector, it was revealed that the facility failed to report all the incidents involving Resident #1 (R1) to CCL. R1 sustained multiple unwitnessed/witnessed falls in care, however, only (2) Unusual incident/injury reports were submitted to CCL by the facility administration. The current facility administrator was unable to locate any additional SIRs sent for the other reported Incident Reports after checking the facility files and computer database.

Deficiency is noted on LIC 809D. Exit interview, a copy of this report and Appeal Rights were provided to Subashsani Kumar, Executive Director .