Facility Evaluation Report

Licensing Program Analysts (LPAs) Quoc Huynh and Trevor Byrne arrived to the facility begining at 11:18 AM to conduct an unannounced Case Management - Deficiencies visit at the facility today. LPA met with facility Executive Director (ED) Grace Hartnett entrance interview conducted and the reason for the visit was explained.

The purpose of today’s visit was to follow-up on two (2) self-reported incidents that occurred on 01/26/2026 and 02/14/2026 and one (1) self-reported death report that occurred on 01/29/2026. During today’s visit, the LPA conducted a physical plant tour and an interview with the Executive Director (ED) between approximately 11:25 AM and 04:30 PM.

On 02/11/2026 at 06:59 PM Community Care Licensing Division (CCLD) received a self-reported incident report regarding an incident that occurred on 01/26/2026. On 02/27/2026 at 09:56 PM CCLD received a self-reported incident report regarding an incident that occurred on 02/14/2026. On 02/11/2026 at 05:27 PM CCLD received a self-reported Death report regarding an death that occurred on 01/29/2026. LPA interviewed the ED and asked why the reports were not submitted to CCLD in a timely manner. ED explained that they were investigating whether a previous fall was reported but otherwise did not have a justification as to why the incidents and death was reported to CCLD outside of the required timeframe. LPA informed ED that a written report shall be submitted to the licensing agency and to the person responsible for the resident within seven (7) days of the occurrence any incident which threatens the welfare, safety or health of any resident or the death of any resident from any cause regardless of where the death occurred. ED confirmed that they are aware of the reporting requirement and agreed to submit the list of individuals from the facility who will be responsible for submitting reports to CCLD in a timely manner for all future reports.

Pursuant to Title 22, California Code of Regulations, the following deficiency was cited (refer to LIC 809-D.) Exit interview conducted and copy of the report and appeal rights were issued.