Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Dolores arrived to the facility unannounced to open a complaint investigation. During visit, a case management - deficiencies visit was conducted due to violations observed. LPA met with Designated Administrator, Renee Sabankaya.

On two occasions, a resident (R1) was sent for medical treatment to Emergency Psychiatric Services (EPS). Based on review of the facility's incident reports, the facility did not submit an incident report to the Department for both occasions.

During visit, staff provided the incident reports to designated Administrator and LPA. Based on interview, the incident reports were not seen by the designated Administrator therefore could not confirm if the incident reports were sent to the Department.

LPA printed out the Title 22 regulation on reporting requirements and provided the section to the designated Administrator. LPA advised the designated Administrator to ensure staff are filling out each section on the incident report to include the second page. Designated Administrator stated understanding.

In the dining room, LPA observed a cracked mirror panel with cracked shards on the wall that is not observed covered. Based on interview it was stated R1 had broken the mirror with an object more than three months ago. LPA advised facility to ensure the cracked mirror is covered to ensure resident's safety while they wait for repair. Designated Administrator stated understanding.

Deficiencies were cited per California Code of Regulations, Title 22. See LIC809-D. This report was reviewed with Renee Sabankaya and a copy of the report and appeal rights were provided.