Facility Evaluation Report

Licensing Program Analyst (LPA) Huma Rahimi conducted unannounced visit to this facility in conjunction with a complaint control # 31-AS-20260304131625. LPA met with Staff #2 (S2) who granted access to facility. The Administrator was contacted LPA explained the reason for the visit. The Administrator at around 10:00 AM.

During the visit, the LPA was informed that Resident #1 (R1) experienced a panic attack on 02/26/2026 , and 9-1-1 was called . R1 was transported to the hospital for further evaluation. Additionally, on 02/12/2026 , Resident #3 (R3) experienced confusion, and 9-1-1 was called . R3 was also transported to the hospital. However, the facility failed to submit Unusual Incident/Injury Reports to the Community Care Licensing Department (CCLD) within the required time frame. The LPA reviewed the incident reporting system and did not observe any incident reports submitted for the above events involving R1 and R3. The Administrator acknowledged that incident reports were not submitted to the Regional Office (RO) for these occurrences. According to Title 22 Regulations, a written Unusual Incident/Injury Report must be submitted to CCLD within seven (7) days of the occurrence. The LPA informed the Administrator that all staff members are mandated reporters and are responsible for ensuring reportable incidents are submitted to the Department in a timely manner.

The LPA instructed the Administrator to submit incident reports to the Regional Office for the following incidents :

02/12/2026 – Resident #3 (R3) transported to the hospital after experiencing confusion

02/26/2026 – Resident #1 (R1) transp orted to the hospital after experiencing a panic attack

Appeal rights explained and exit interview conducted. Copy of this report signed and delivered.