Facility Evaluation Report

Licensing Program Analyst (LPA) ,Talwinder Bains arrived at the facility unannounced on 08/29/24 to do case management visit and met with Program Administrator, Latisha Woodson and explained the purpose of the visit.

During a facility visit at the facility on 08/27/2024, the Department learned of an incident with R1. Based on the records reviewed and staff’s interviews, it has been determined that the facility did not submit a report incident (SIR) to the Department regarding R1. Information obtained indicated on 08/08/2024, R1 had a change in condition and bruising was found. The facility admitted they failed to follow Title 22 reporting requirements as well as failed to submit an SOC341/ Suspected Physical Abuse.

Additionally, on 08/28/2024, the facility submitted an SIR and SOC341 to the Department regarding missing funds at the facility for resident, R1. Based on the documentation, the incident occurred on 08/17/2024. The facility did not report this incident within the required time frame.

Based on gathered information, it has been concluded that facility did not meet reporting requirements as required per Title 22 §80061(b). Additionally, it has also determined that facility’s administrator did not fulfill their duties as indicated per Title 22 §80064 for Administrator’s Qualifications and Duties.

Based on this information, per California Code of Regulations, Title 22 Division 6, Chapter 8, deficiencies are being cited on the attached LIC809-D page.

Exit interview was conducted, copy of this report and appeal rights were provided. Civil penalties shall be assessed if facility does not comply with POC requirements which were issued today.