Facility Evaluation Report

This report has been amended to reflect revised wording. A telephonic review was conducted on August 29, 2025 , at 1:43 p.m. with Rizaandrea Vitug - Assistant Administrator to confirm the changes. LPA emailed the amended report for signature, and it will remain on file.

Licensing Program Analyst (LPA) Erica Mosley conducted a Case Management - Deficiencies visit.

During the Department’s investigation of complaint # 29-AS-20250220154549, the following deficiencies were observed. On 12/30/2024, Resident #1 (R1) reported to the Administrator that R1 was sexual assaulted by Staff #1 (S1) during the evening of 12/29/2024. However, the Administrator did not submit the Unusual Incident/Injury Report (UIR) to Community Care Licensing (CCL) until 01/08/2025. Due to the nature of the allegation, the suspected abuse should have been reported within 24 hours to CCL, Long Term Care Ombudsman (LTCO), and the local police. In addition, the information in the UIR was incorrect. The Administrator reviewed the facility Ring video footage on 12/30/2024 and discovered that S2 had entered R1's room the night before. Both the facility Supervisor and the Administrator were aware S2 entered R1’s room on the night of the incident and not S1. However, the incident report only reflected what R1 reported to the Administrator.

The facility manager stated that staff were sleeping in the basement room which also serves as a lounge for employees and did not see anything wrong with the employees living in the basement room.

The following deficiency was observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Assistant Administrator was made aware that failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.