Facility Evaluation Report

Licensing Program Analyst (LPA) Rachael De Leon conducted a Case Management - Deficiencies visit in conjunction with a complaint visit (Complaint Control #29-AS-20200921120015). LPA De Leon met with Cheryl Marsh. The purpose todays visit is to issue citations for deficiencies observed during the complaint investigation.

During the complaint investigation of complaint #29-AS-20200921120015, the following deficiencies were observed:

R1’s Physician Report was dated 08/23/18. R1 was noted to have “Baseline Dementia” during a 09/05/20 ER visit. There was no updated Physician Report provided due to R1’s change of condition.

R1’s Resident Evaluation was updated 08/03/2020 – there are no signatures/dates from appropriate parties on the updated evaluation. R1’s evaluation was not updated when R1 began having behaviors of throwing self out of bed to cause self-harm and was diagnosed with “Baseline Dementia” during a 09/05/2020 ER visit.

Resident #1 (R1) had a fall on 7/31/20 and 09/05/20. The Wilshire Home Health reports for September 2020 indicate R1 had a stage two pressure injury on right buttocks, a stage one pressure injury on sacrum, and a stage one pressure injury on coccyx area. R1 was diagnosed with a Urinary Tract Infection (UTI) on 09/05/21. No Special Incident Reports (SIRs) were submitted to Community Care Licensing (CCL).

Exit interview conducted, deficiencies cited, copy of report and appeal rights issued.