Facility Evaluation Report

Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced case management visit to issue a deficiency identified during an unrelated complaint investigation. LPA identified herself to, was greeted by, and explained the purpose of the visit to Caregiver Dario Gonzalez. LPA spoke to Administrator Brenda Gonzalez via phone.

During a complaint investigation, the Department interviewed clients, staff, and outside sources, reviewed facility records, and conducted a tour of the facility. During the investigation, it was determined that Client 1 (C1) was considered a fall risk. [LPA provided Dario with an LIC811 Confidential Names list to identify C1] Review of C1’s physician’s report dated January 2020 revealed that C1’s physician report was not updated to reflect C1’s fall risk diagnosis. Review of C1’s assessment records and interviews with facility staff and management revealed that C1’s records had not been updated to show that C1 was a fall risk, but facility staff had been verbally informed that C1 was a fall risk by the Administrator. Although C1’s physician had deemed C1 as a fall risk, C1’s physician report and appraisal documents had not been updated to reflect C1’s change in condition.

The following deficiency is cited per California Code of Regulations, Title 22 and noted on the attached LIC809-D page.

An exit interview was conducted with Administrator Brenda Gonzalez via phone and Caregiver Dario Gonzalez, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 01/16).