Facility Evaluation Report

Licensing Program Analyst (LPA) Kristin Kontilis conducted a Case Management visit to address deficiencies noted during Complaint Control #29-AS-20260427163728. The Case Management visit is being conducted to address CCLD’s concerns that were observed during the course of the investigation. LPA Kontilis met with Administrator Robert Glock and explained the purpose of the visit. Long Term Care Ombudsman Diane See participated in the visit.

During the complaint investigation, interviews conducted and records reviewed revealed 9-1-1 was called for Resident 1 (R1) when R1 experienced an unwitnessed fall. Records reviewed and interviews conducted revealed the facility failed to submit a Serious Illness/Serious Injury report to CCLD regarding R1’s unwitnessed fall. Administrator Glock acknowledged there is no record of an incident report being sent to CCLD regarding a fall R1sustained resulting in 9-1-1 being called and R1 was transferred to the local hospital.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D):

Exit interview conducted. Civil Penalty Assessed. Copy of report and Appeal Rights issued via email.