Facility Evaluation Report

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management visit to conduct a Health & Safety Welfare Check. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Site Manager Anafe Rivera.

During today’s visit, LPA performed a facility tour / welfare check, collected and reviewed select resident care records, and interviewed staff. Staff interviews corroborated to show:

a) On 02/10/2024 during the overnight shift, Resident #1 (R1) closed the drain of their sink in their private bathroom, and then let the sink faucet run continuously. [See LIC811 Confidential Names List for a description of person identifiers use in this report.] Staff, who were not required to be awake at this time, were not immediately aware of the problem. The result was that water spilled onto the facility’s floor, flooding R1’s bedroom, two adjacent bedrooms and their corresponding bathrooms, and one edge of the facility’s dining room. Multiple staff spent a few hours cleaning up the water. None of the facility’s residents needed to be relocated. Per LPA review of CCLD’s database, the Department did not receive a written report from Licensee describing this incident, as was required to be submitted within seven (7) days of occurrence.

b) On 02/16/2024, R1 passed away at the facility, under the concurrent care of a hospice agency. Per LPA review of CCLD’s database, the Department did not receive a written report from Licensee describing R1’s death, as was required to be submitted within seven (7) days of occurrence.