Facility Evaluation Report

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a case management visit and met with Administrator, Kasandra Guerrero. The purpose of this case management visit is to follow up on two self-incident reports submitted to the Department notifying about resident's (R1) hospitalization.

According to incident report dated 4/21/25, on 4/18/25 at approximate 9am, Administrator observed R1 having hard time breathing, Administrator called the paramedics who transported R1 to the hospital for further evaluation and responsible parties were notified. R1 returned to the facility on 4/20/25 with no new medications. Per second incident report dated 4/24/25, on 4/22/25, staff on duty observed R1 who appeared weak and stated that they were having difficulty breathing; Oxygen saturation taken was low at 88%, then paramedics were called again and transferred R1 to the hospital again for further evaluation. According to Administrator, R1 was transferred to skilled nursing for treatment.

During today's visit, LPA also followed up on recent fire clearance update request submitted by the facility on 4/7/25 along with required documentation including Application indicating additional room without structure construction (LIC200), facility updated sketch, Emergency Disaster Plan (LIC610E), control of property, Personnel Report (LIC500), addendums to plan of operation addressing safety issues, activities, food service or any area of the facility operation that might be impacted by change of rooms. LPA toured the new room and observed a large area with required furniture items as follow: a portable closet, lamp, three drawer night stand, recliner and bed with adequate supplied with a mattress, good springs, pillow and bedding linens. According to Administrator, the fire department is expected to come today and inspect the room for further approval. LPA have confirmed with Administrator understanding that they will need updated fire clearance approval prior to admit a new resident to the facility. Exit interview was conducted with Administrator and a copy of this report was given.