Facility Evaluation Report

Licensing Program Analyst (LPA) Jason Lund arrived unannounced to do a case management visit. LPA Lund met with Care staff Antonio Bugas and who called Administrator Maria Payla and explained the reason for the visit. Administrator Maria Payla gave permission to Care staff Antonio Bugas sign required paperwork. Census: 3

LPA Lund was investigating a complaint investigation regarding resident (R1). It was reported to licensing that R1 had multiple falls. On 10/15/2024 the staff informed the family that R1 had a fall and was transported to the Emergency Room (ER). The facility didn’t report the falls (Injuries) to licensing as well R1 going to the hospital. The facility failed to fill out an Unusual Incident/Injury Report (LIC624) for R1’s fall on 10/15/2024.

Per California Code of Regulations, Title 22, the following deficiencies, and immediate civil penalty have been issued for repeat violation.

Exit interview conducted and report provided. Appeals rights printed.