Facility Evaluation Report

Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct a case management visit - health and safety check. LPA Valerio met with facility staff, and explained the purpose of the visit. LPA was later met by Administrator Elaine Tolentino.

LPA Valerio received notification from an outside agency regarding COVID positive residents and staff inside the facility. LPA Valerio reviewed the Regional Office (RO) electronic facility files and did not observe any submitted incident reports. LPA attempted to contact the facility on 08/06/24, but did not receive a response. On 08/07/24, LPA Valerio was able to reach Administrator Elaine via cellphone. Initially, Administrator Elaine stated she only had one resident that was COVID positive. After further discussion, it was learned that two residents were COVID positive. Both residents were in a shared room. According to Administrator Elaine, no staff tested positive. LPA inquired about the facility's Infection Control Procedures. Due to the facility's full capacity, Administrator Elaine stated there was no available room to be utilized as an isolation room. Administrator Elaine admitted that an incident report was not sent for the COVID cases. LPA requested they be sent to the RO. The RO received two incident reports on 08/08/2024.

According to the Unusual Incident Reports (UIR) received, Resident 1 (R1) returned from the hospital on 07/21/24. Staff observed R1 displayed cough symptoms. R1 tested positive for COVID on 07/25/2024. R1 was in a shared bedroom with Resident 2 (R2). R2 was not removed from the room, and R1 was not isolated per the facility's infection control procedures. On 07/28/2024, R2 was observed to have symptoms of a cough and tested positive for COVID.

Per California Code of Regulations (CCR) - Title 22, deficiencies are being cited on the attached LIC 809 - D. Appeal rights provided. Failure to correct deficiencies may result in the issuance of civil penalties. An exit interview held, and a copy of the report was provided to Administrator Elaine.