Facility Evaluation Report

Licensing Program Analyst (LPA) Manuel Monter arrived unannounced visit to open a complaint investigation. During the complaint investigation, a case management deficiencies visit was conducted due to violations discovered during the investigation process. LPA met with Administrator Anelli Stamm.

While investigating the complaint 26-AS-20240529150017 , LPA reviewed facility incident reports for resident R1 from January 2024-June 6, 2024. Based on a review, the facility did not send any incident report for Resident R1, from January 2024- June 6, 2024.

While reviewing resident R1's facility file, documentation notes that R1 was seen at the hospital on 1/9/2024, 1/13/2024, 5/24/2024. ADM stated she does not know if the incident reports were sent as she does not have a fax confirmation for R1's hospital visits. LPA interviewed staff S1 who stated he/she did fax those incident reports, but does not have fax confirmation numbers.

Further review of the facility's internal incident report records, R1 had fallen on the following dates; February 7, 2024, March 2 and 7, 2024, and May 13, 2024. LPA interviewed staff S1. S1 stated he/she did not send incident reports for these falls because R1 did not go to the hospital. S1 stated he/she would send incident reports regrading falls in the future.

Deficiencies are being cited per California Code of Regulations, Title 22. See LIC809-D. This report was reviewed with A dministrator Anelli Stamm and a copy of the report and appeal rights were provided.