Facility Evaluation Report

Licensing Program Analysts (LPA) Brian Balisi conducted an unannounced Case Management - Deficiencies visit in conjunction with a complaint visit (Complaint control # 29-AS-20240416124733). LPA met with Elena Kordonsky and explained the reason for the visit. The purpose of this visit is to issue citations for deficiencies observed during the complaint investigation which were not related to the complaint.

During the complaint investigation, LPA conducted a Residents records review at approx 10:30am and revealed that the facility does not maintain accurate resident records. Two (2) out of Five (5) resident records reviewed did not have a centrally stored medication record, complete resident appraisal, preplacement, needs and services plan, and complete hospice records.

Pursuant to Title 22 CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D):

Exit interview conducted/Citations issued/ Appeal Rights Discussed/ Copy of this report issued.