Facility Evaluation Report

On 11/06/2024, at approximately 10:50 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a Case Management - Annual Continuation inspection and met with Froilan Devera, Administrator. Licensee, Carl Resurreccioa arrived at approximately 11:20 AM, and Licensee, Julie Martuscello arrived at approximately 11:40 AM.

At approximately 11:05 AM, LPA reviewed 4 staff files and 4 client files. 4 of 4 staff files reviewed had all then required documentation per regulation, including proof of current First Aid and CPR training. 4 of 4 client records reviewed were observed missing the LIC625 Needs and Services Plan which have not been updated and reviewed with each client and/or their respective responsible party within the last year as required per regulation. Additionally, 4 of 4 client records reviewed were missing a Consent for Emergency Medical Treatment. Further, Client 1 (C1) and Client 2 (C2) were missing a signed and dated LIC601 ID and emergency information form and the required CCL Personal Rights LIC613 form. Lastly, the LIC601 ID and emergency information form was missing for Client 3 (C3). (See LIC809D.)

Licensee states facility coordinates the residents' medical and dental appointments as needed and provides transportation to and from these visits. LPA reviewed residents' P&I records and medications and medication records which are all maintained in compliance with regulation.

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Exit interview conducted with Administrator and Appeal rights were given. Signature on form confirms receipt.