Facility Evaluation Report

Licensing Program Analyst (LPA) Patricia Velazquez conducted an unannounced Case Management visit to Kamstra Care Home. LPA Velazquez met with Administrator Runette Catibog. During the complaint investigation visit with Complaint Number: 22-AS-20220923152100, LPA Velazquez questioned ADMIN Catibog regarding the facility's lack of submission of an LIC 624 Unusual Incident/Injury Report for R2's hospitalization on September 22, 2022. ADMIN Catibog confirmed that an LIC 624 was not submitted to Licensing pursuant to statute and regulation.

LPA Velazquez printed Title 22 Regulation Section 87211 Reporting Requirements and provided Administrator Catibog with consultation regarding adherence to this regulation. LPA Velazquez also advised ADMIN Catibog to participate in the Provider Informational Calls as well as staying abreast with the Provider Information Notices (PINs) which can be found on the CCLD website.

Deficiencies cited under California Code of Regulations Title 22 Division 6 Chapter 8. An exit interview was conducted with Administrator Runette Catibog and a copy of this report along with the appeal rights, LIC 811, LIC 9098 and were provided at the time of this visit.