Facility Evaluation Report

Licensing Program Analyst (LPA) Angela Hood arrived unannounced today, 5/23/24, and met with the Administrator, Persida Pop, to conduct a case management visit regarding information obtained during a complaint investigation, #59-AS-20240112110717, that was completed on 5/23/24.

Emergency Medical Services (EMS) Prehospital Care Report dated 12/28/23 indicated that EMS was dispatched to the facility due to the owner reporting that resident (R1) was having chronic diarrhea for 3 weeks and new weakness. EMS report indicated that R1’s Power of Attorney (POA), R1, Administrator, and care staff stated that R1 was unable to self-administer insulin that evening, due to weakness.

Interview with the Administrator indicated that they had a meeting with R1’s POA and physician by phone regarding chronic diarrhea and not eating. Administrator indicated that R1 was not receiving hospice services and was declining. Administrator indicated that R1 is not able to self-administer insulin during the PM shift. Care notes provided by the facility for the month of December 2023 did not indicate any instances of R1 having diarrhea or not being able to self-administer insulin.

During the investigation, the Department requested documentation for all incidents where EMS were contacted regarding R1, any communications between the facility and R1’s physician, and incident reports pertaining to R1. Communication with the Administrator indicated that they did not contact R1’s physician and only reached out to the family and home health nurse. The Department requested documentation with correspondence between the facility and R1’s family and home health nurse. To date, the facility was unable to provide the requested documentation.

Due to the information above, per California Code of Regulations, Title 22 Division 6, Chapter 8, a deficiency is being cited on the attached 809-D page.

Exit interview was conducted. A copy of this report and appeal rights provided.