Facility Evaluation Report
At approximately 11:15am Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a Case Management and was greeted by caregiver. Licensee Edward Alicdan arrived later. Facility currently has 6 residents in care, one of which is on hospice, which is allowable per the facility's Hospice Waiver.
Upon arrival at facility LPA and caregiver observed unlocked medication cart in living room ( deficiency cited and civil penalty issued for repeat violation within 12 months, see 809D and LIC421FC ) . Upon arrival LPA and caregiver observed unlocked hallway closet containing toxins ( deficiency cited and civil penalty issued for repeat violation within 12 months, see 809D and LIC421FC ). LPA reviewed Physician's Report for new resident R1 and found it not to be signed by a physician. Per licensee, the unsigned Physician's report is the only one retained by facility for resident ( deficiency cited, see 809D ).
On 3/29/2024 Licensee came to the SRRO for an informal meeting to discuss recent citations and corresponding plans of corrections not fulfilled. Licensee expressed interest in participating in CCL’s Technical Support System (TSP) in order to gain compliance with regulations for which they received deficiency citations.
On 4/4/2024 CCL’s Technical Support Program analyst reached out to Licensee to confirm interest in participation, no response was received. On 4/22/2024 LPA received notification from Technical Support Program analyst advising they have not received a response from licensee to date. TSP analyst advised the licensee that signed participation agreement must be received by 4/25/24. On 5/1/2024 the Technical Support Program analyst sent a closure letter to the licensee, closing the referral due to lack of response by the licensee. Citations issued on 2/8/2024 were cleared during office meeting because Licensee agreed to TSP. Due to Licensee’s failure to respond to and work with TSP to correct identified concerns, deficiencies issued on 2/8/2024 are being re-cited ( deficiencies cited, see 809D ).
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction