Facility Evaluation Report

On 1-5-24 at 11:37am, Licensing Program Analyst (LPA) Michael Bilger arrived unannounced to conduct a case management visit regarding Administrator Qualifications and Duties. LPA met with Administrator Lynn Caoli and explained the purpose of the visit. LPA reviewed documents related to complaint investigation #27-AS-20230914092803. Based on documents reviewed, it was determined that on 9-7-23, resident1 (R1) was witnessed to have leg wound bandages described at "old, dingy, and covered in blood and puss." It was further revealed that R1's bandages were not changed in accordance with R1's care plan, nor bathed in accordance with care plan, which resulted in worsening of leg wounds including maggot infestation on 9-7-23. As a result, it is determined that Administrator did not exercise a provision of service to ensure R1's care plan was followed.

As a result of today's case management, citation are issued under Title 22, Division 6 and noted on LIC 809D. An exit interview was conducted with Lynn Caoli and a copy of this report was provided to Lynn. Appeal rights provided.