Facility Evaluation Report

On today’s date, Licensing Program Analyst (LPA) Rosie Quiroz conducted an unannounced visit for the purpose of conducting a case management deficiency. LPA was greeted and met with Administrator Heather Myers and Richard Mariona, Health Services Director.

During the course of complaint investigation, control number 22-AS-20211005172231, the following deficiencies were observed: Staff 1 (S1) was observed to not be associated to the facility despite being on site more than three days per week and/or 16 hours per week.

Required personnel paperwork for (S1) was observed not to be retained on file at facility as S1 was hired through a temp agency. Facility failed to request copies of pertinent documents to retain on site.

Following R1’s fall on 9/30/2021 and continuous yelling in pain, facility staff did not call 9-1-1 and/or notify R1’s physician of fall and change in condition.

The following is being cited per Title 22, Division 6 of the California Code of Regulations. Civil Penalty assessed during today's visit.

An exit interview was conducted with Administrator Heather Myers and Richard Mariona, and a copy of this report, along with LIC9099-D, LIC 421IM, Appeal Rights, and the LIC 811, identifying confidential names were provided at exit.