Facility Evaluation Report

Licensing Program Analyst (LPA) Jessica Cho conducted an unannounced Case-Management-Deficiencies visit and met with Executive Director Bob Fiorentino by telephone and in person with North Executive Director Selene Lopez, Assistant Executive Director Maggie Pantaleon, and Shores Program Director Danica Coronel and explained the reason for the visit.

During the investigation of Complaint Control #: 22-AS-20250130140500, the following deficiencies were discovered: The investigation revealed that when facility care staff assignments from November 19, 2024, were requested, Staff #1 (S1) indicated that caregiver assignments have been archived while Staff #2 (S2) indicated that caregiver assignments are only kept for 90 days which is in violation of the Title 22 regulation requiring records to demonstrate adequate staff coverage necessary for facility operations be retained. Based on the review of records, the facility was not updating documented behaviors of Resident #1 (R1) from September 2024 to October 2024 on the service plan dated/effective on December 15, 2024. The service plan documented the incidents occurring in November 2024. The incidents never addressed the increase and frequency of R1’s aggressive behaviors and if additional staff was needed to meet the behavioral needs of R1. Additionally, the facility did not self-report any incidents involving R1 documented in the facility’s Progress Notes dating back from August 13, 2024 which is in violation of the Reporting Requirements which also includes any incidents which threatens the welfare, safety, or health of any resident. Therefore, deficiencies are being cited as per the Title 22, Division 6, Chapter 8 of the California Code of Regulations. See the attached LIC809Ds. An exit interview was conducted with Executive Director Bob Fiorentino by telephone and in person with North Executive Director Selene Lopez, Assistant Executive Director Maggie Pantaleon, and Shores Program Director Danica Coronel, and a copy of this report wiht the appeal rights were provided at the end of the visit.