Facility Evaluation Report

On today's date, Licensing Program Analyst (LPA) Rosie Quiroz conducted an unannounced visit for the purposes of conducting a case management deficiency in connection to the investigation completed under complaint control number: 22-AS-20221110131242. LPA Quiroz was greeted and granted entry into the facility by Administrator Ngoc "Nick" Mai and explained the reason for the visit.

During course of the investigation, the Department interviewed staff and witnesses as well as reviewed and obtained pertinent documentation.

Hospital records confirm that R1’s responsible party informed hospital staff that R1 was not brought in by their caregiver due to caregiver having two other people to take care of. Facility was cited for lack of staffing on 2/07/2023 during a Case Management inspection by the Department. As of today’s date, the Plan of Correction has not been met.

When interviewed regarding the fall, the Administrator reported they did not submit a written unusual incident report (UIR) to the Licensing Department as they didn’t think it was necessary as they believed R1 to be improving. The Administrator further reported they did not contact 9-1-1 as they believed the family would handle R1’s medical needs and that by contacting R1’s family, the Administrator believed he had met his Administrator duties.

Following R1’s fall it was reported R1 was no longer able to walk. Hospital records from 11/09/2022 confirm R1 sustained a closed hip fracture. Despite the change in condition, no updated reappraisal was observed on file.

In addition to the above noted incident, hospital records note R1 was hospitalized on 8/26/22 due to being hypotensive. While there, blood glucose levels for R1 were noted to be 244.

The following is being cited per California Code of Regulations, Title 22 Division 6 Chapter 8. (SEE LIC 809-D Pages)

An exit interview was conducted with Administrator and a copy of this report, confidential names list and appeal rights was provided at the time of exit.