Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Wong conducted a case management visit as a result of a file review conducted in relation to complaint #28-AS-20230630104521

While LPA reviewed R1's file and observed R1's file did not have a complete record. There's only LIC603 Preplacement Appraisal Information in the resident's file. In addition, LPA asked administrator about R1's fall incident and incontinence incident on June 20th and 28th, 2023, if the facility sent any unusual incident report to Licensing. Administrator said she did but LPA reviewed the CCL internal incident reports and nothing was in the system.

The following deficiencies are noted under the California Code of Regulations Title 22 Division 6 on LIC 809D

Exit interview conducted, copy of the report and appeal rights were given.