Facility Evaluation Report
Licensing Program Analyst (LPA) Steve Chang conducted an unannounced case management visit and met with Administrator (ADM) Marife Duewel.
The purpose of today's visit is to deliver an amended LIC9099 and LIC9099D report which were incorrectly issued on 3/6/2025 that should have been a case management..
Below is the exact component in LIC9099 and LIC9099D:
On 3/6/2025, Licensing Program Analyst (LPA) Steve Chang conducted an unannounced initial investigation visit and met with Administrator (ADM) Marife Duewel.
LPA requested resident roster and LIC500 Personnel Report. LPA requested the physician reports, appraisal needs and service plans, and progress notes of resident R1.
On 2/27/2025, resident R1 had a fall resulting in fracture and was sent to hospital.
The Department did not receive incident regarding R1's incident on 2/27/2025. ADM stated the facility did not send the incident report yet but is planing to send the incident report. LPA reminded ADM the incident report needs to send within 7 days. Citation was issued today. See LIC9099-D.
The report was provided to ADM for signature. A Copy of the report was provide to ADM.
Exit interview was conducted with ADM. The report was provided to ADM for review and for signature.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction