Facility Evaluation Report

At approximately 9:45am, Licensing Program Analyst (LPA) Loera arrived unannounced to conduct a Case Management - Incident Visit and met with Administrator, Elena Davidenko and Executive Director, Kyle Ruth-Salas. The purpose of the visit was to follow up on a self-reported incident that was submitted to Community Care Licensing (CCL) on 12/26/2024.

Incident report states on 12/25/2024 Resident 1 (R1) had pressed their emergency pendant in response to a fall to request staff assistance at approximately 2:49am. The security guard monitoring the system did not notify staff on duty of the alert and the call for assistance was not answered in a timely manner. (Deficiency Cited)

Administrator conducted an in-service training on response protocols and training on pendant response. Deficiency was cleared during visit.

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Exit interview conducted. Copy of report, LIC809D (Deficiency Page), and Appeal Rights discussed and provided to Administrator.