Facility Evaluation Report

On 4/12/24 Licensing Program Analyst (LPA) Maja Jensen arrived at the facility unannounced to open a complaint investigation for compliant number 27-AS-20240404104236. LPA Jensen met with Angela Chicas and explained the purpose of the visit. LPA Jensen also spoke to the Licensee/Administrator by phone and explained the visit.

While investigating the above listed allegation, it was learned that the facility had accepted a resident (R1) without creating and/or maintaining resident records as required by the California Code of Regulations (CCR) Title 22, Division 6, Section 87506. LPA Jensen asked the Licensee/Administrator asked the Licensee/Administrator which records were required prior to accepting a resident and she stated she was not aware. LPA Jensen reviewed the file for Resident 2 (R2) and observed no pre-placement appraisal and no physician's report (LIC 624). A review of the resident file for R2 revealed that R2 requires assistance for all Activities of daily living and is on hospice. During the course of this visit, a hospice nurse arrived to check on R2. LPA Jensen interviewed the hospice nurse who stated R2 has an unstageable sacrococcyx wound. R2 has at least 2 prohibited health conditions and no documentation was found that describes the type and frequency of the care tasks to be performed by the facility staff.

During the course of the investigation for complaint control number 27-AS-20240223144547, the Licensee/Administrator advised she was not aware that a copy of the admission agreement must be provided to the resident or responsible party upon signing.

Deficiencies are being cited from CCR, Title 22, Division 6. Failure to correct deficiencies may result in the assessment of civil penalties. . An exit interview was conducted and a copy of this report