Facility Evaluation Report

On 05/29/2025 at 03:00 PM, Licensing Program Analyst (LPA), Melody Brown, met with Assistant Administrator Mary Gonzalez at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) San Bernardino (SB) Regional Office to initiate a case management deficiency. The investigation consisted of observation, interviews ,and a review of pertinent documentation.

During Department staff investigation, the discrepancies were noted regarding the dates of Resident #1 (R1) fall which caused the ankle injury: the facility incident report stating it occurred on 7/25/2023; R1's primary physician records appearing to state it occurred on 7/23/2023; and the report by the orthopedic physician's assistant stating the injury occurred on 7/21/2023. Moreover, Department staff records review indicated that R1 went to the Emergency Room (ER) on 7/25/2023 which is multiple days after R1 fell out of R1’s wheelchair and an apparent delay in seeking medical attention. During the Office Visit today, 05/29/2025, Assistant Administrator Gonzalez was informed that deficiency will be issued.

An exit interview was conducted where this report (LIC809), LIC809D) and Appeal Rights were discussed and provided to Assistant Administrator Mary Gonzalez.