Facility Evaluation Report

Licensing Program Analyst (LPA) Fernandes-Goes arrived unannounced with the purpose of closing a complaint investigation. During subsequent complaint investigation LPA learned that there are related deficiencies observed during the visit. LPA met with Ric Pielstick - Executive Director. Following item was observed during investigation visit:

Department has learned that resident R1 had a fall on 7/22/2022 and R1 was sent to the ER, however; incident report was not provide/submitted to Department until LPA was visiting facility on 8/3/2022. In addition, Resident R2 had a medication refusal on 8/3/2022 that wasn’t reported to the Department. It was learned while reviewing records. (see records, LIC 809-D)

The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.