Facility Evaluation Report

This unannounced Case Management – Deficiencies inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of issuing citations for deficiencies observed during the investigation into Complaint Control No. 22-AS-20240724111701. LPA met with Administrator (AD) Michelle Song and explained the reason for today’s inspection.

During the course of the investigation, Department staff inspected the facility, interviewed staff, and obtained and reviewed copies of the resident roster, staff roster, an Incident Report dated July 15, 2024, and Resident #1’s (R1) UCI Medical Records.

Per an Incident Report dated July 15, 2024, on July 15, 2024, at 9:00AM, R1 was found with a right swollen leg and sent to the hospital. R1’s UCI Medical Records and staff interviews revealed that R1 was diagnosed at the hospital with a femur fracture as a result of this incident. However, based on Orange County Regional Office (OCRO) records, the facility did not submit the Incident Report dated July 15, 2024, to the OCRO or submit any other incident reports regarding this injury as required.

Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.