Facility Evaluation Report

On 9/19/22 at 10:15am Licensing Program Analyst (LPA) Maja Jensen arrived at facility unannounced to conduct a case management for deficiencies. LPA Jensen met with care staff at the facility and was directed to 1215 W Swain Road which is the address for licensed care facility Delta at the Sherwoods. LPA Jensen met with Craig Vincelet at 1215 W Swain Road and explained the purpose of today's visit.

Community Care Licensing received an LIC 624 on 9/15/22 for a resident that signed out of the facility on 9/2/22 and did not return. LPA Jensen reviewed the submitted LIC 624 for this incident and observed the facsimile transmission to be time stamped with a date and time of 9/14/22 at 9:49am. The facsimile transmission also indicates that a phone call to number (916) 263-4700 was placed to Community Care Licensing to provide verbal notification. There is no indication on the LIC 624 indicating when the phone call to Community Care Licensing was placed. LPA Jensen requested a copy of resident 1's (R1) physician report and based on a review of this record determined that R1 can leave the community unassisted. LPA Jensen also requested a copy of the sign in and sign out log. LPA Jensen reviewed the sign in and sign out log and verified that R1 signed out on 9/2/22. Based on the records reviewed. LPA Jensen determined that the incident was not reported in writing within 7 days.

Deficiencies are being cited as a result of this case management from the California Code of Regulations, Title 22, Division 6.

An exit interview was conducted and a copy of this report, an LIC 811 along with appeal rights was given to Craig Vincelet.