Facility Evaluation Report

On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of documenting deficiencies observed during the investigation of the allegation included in complaint 22-AS-20230119153437.

It was determined over the course of the investigation that half rails were in place on resident R1's bed when resident sustained a fall incident early in the morning of January 18, 2023. Based on interview with the facility's administrator and records reviewed during an initial investigation visit conducted in January, there were no physician orders in place to authorize the use of postural supports at the time. LPA observed the unit during today's visit. The half rail was noted to be present and mounted to the bed in the lowered position. LPA requested to review the resident's file for the presence of a doctor's order which was provided.

Additionally, it was determined that no incident report for the fall and subsequent hospitalization on January 18, 2023 were submitted by then administrator Hyo Sook Kim before the complaint investigation visit conducted on January 28, 2023. LPA provided a consultation with the current facility regarding the implications of making potentially false statements to a licensing agent.

Two Type B deficiencies are cited according to Title 22 of the California Code of Regulations.

An exit interview was conducted and a copy of this report along with appeals rights was provided and left to facility representative.