Facility Evaluation Report

**This report was amended to include language for the further review of H&S 1548.**

Licensing Program Analyst, LPA, Noel Wolf Petersen arrived unannounced to the facility to deliver findings of a department report investigating a complaint with the allegation of staff did not prevent a resident from sustaining a fracture while in care found to be unsubstantiated after investigation. LPA met with Emila Baguinon, designated representative of Starbloom Care Home via a LIC 308 to explain the purpose of the visit. The investigative report also concludes that the staff failed to seek timely medical attention for the resident.

In interviews, 3 staff and the administrator noticed the resident expressing pain related to their arm on 11/17/2025. The administrator asked staff to monitor and communicate if there was a bruise or swelling. Two staff reportedly noticed a bruise on 11/18/2025, when asked about the size of the bruise, the administrator gave a statement, "the bruise covered the upper area of the arm near the shoulder and it appeared swollen." The administrator asked staff to apply ice to the affected area. On 11/19/2025, the administrator arrived in the early afternoon, made an observation of the bruise, asked staff to apply ice, and told staff she would return later in the afternoon to take the client to the hospital. The resident was brought to the emergency room on 11/19/2025 around 9pm, consultation was dated 11/19/2025 11:57 pst.

Based on the departments observations, interviews, and record review(s),

The following deficiencies were observed (see 809-D) and cited from the California Code of Regulations, Title 22, and California Health and Safety Code. This incident is currently under review and a future civil penalty may apply based on 1548 H&S. Failure to correct the deficiencies may also result in civil penalties. Exit interview conducted and appeal rights provided.

A copy of the report was read and given to the administrator/designated representative. A citation of this type, meets the criteria for a 500$ immediate civil penalty attached on a following LIC 421IM.