Facility Evaluation Report

Licensing Program Analyst (LPA), Angela Panushkina, conducted a CASE MANAGEMENT visit at this facility to issue deficiency in conjunction with complaint control no.: 31-AS-20221110143440 and met with a Regional Operations Specialist. LPA explained the reason for the visit.

Although, the LPA received an email notification from the Executive Director on 11/06/22 regarding the incident between R1 and R2, the actual Incident Report (LIC624) was never submitted to the Community Care Licensing Department (CCLD) in a timely manner. Based on Title 22 Regulation: a written Unusual Incident / Injury Report shall be submitted to CCLD within seven (7) days of occurrence.

At the time a civil penalty of $1,000.00. was issued (repeated violation) and a citation was recorded on LIC809D.

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