Facility Evaluation Report

On July 21, 2023, Licensing Program Analysts (LPAs) Komal Charitra and Grace Donato conducted an unannounced case management visit to follow up on a visit made on 11/10/2022. LPAs met with Co-Administrator Kelly Ancheta and Administrator, Antolin Ucol and explained the purpose of the visit.

On 11/7/22, the Licensee reported that Staff 1 (S1) was found deceased in the facility garage. The Department investigated this case and found that there was neglect and lack of supervision on the residents as a result of S1 passing away while on duty. In addition, the investigation found that the residents were not attended to or checked on during the overnight shift. Based on the interviews conducted during the investigation, it was unknown to other staff and licensee that the staff had passed away.

Furthermore, LPA interviewed the Administrator, Antolin Ucol and reviewed resident files. Based on file reviewed, there is a resident (R1) who is required to be checked on and changed at night due to R1 being incontinent. According to Administrator, there was no staff plan of operation in monitoring the staff working NOC shift. In addition, according to the administrator, staff working NOC shift did not document and/or track whether R1 was being checked on or changed throughout the night.

Furthermore, based on interview conducted with the Administrator, it was indicated that from November 2022 when S1 passed away till June 2023, there has not been a NOC shift staff member on duty.

Deficiencies of the California Code of Regulations, Title, 22 cited on the LIC809-D. Failure to correct the deficiencies may result in additional civil penalties.

Report is reviewed with Co-Administrator, Kelly Ancheta and a copy is provided with appeal rights.