Facility Evaluation Report

Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct a case management visit. LPA met with Administrator Ashkan Bastani and explained the reason for the visit. During the investigation of complaint # 22-AS-20251030090606 it was discovered that Resident 2 suffered a fall and was taken to the hospital to be treated. The facility Administrator notified the family of Resident 2 but did not report the incident to the Agency (Community Care Licensing). This is a violation of Title 22, California Code of Regulation (CCR) 87211 which states, "(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1)(D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident." LPA consulted with Administrator concerning reporting requirements. Deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of the report provided along with appeal rights.