Facility Evaluation Report

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Licensee, Angelina Crudo, to conduct a case management visit.

During a separate investigation conducted by the Department, it was discovered that resident (R1) passed away on 5/7/2023 per R1's certificate of death. Facility was unable to produce a death report when requested at the start of the investigation on 4/03/2024. Licensee stated that they had not reported R1’s death to the Department as R1 was on hospice and Licensee was unaware that hospice deaths were to be reported to the Department.

Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 809-D page regarding reporting requirements.

Exit interview was conducted with Licensee. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents.