Facility Evaluation Report

On 08/23/2023, Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced visit to this facility to conduct a case management visit regarding a resident on resident altercation that involved 3 individuals on 08/20/2023 at 3:45 AM. The LPA identified herself, the purpose of the visit and asked to speak with the Designated Facility Administrator. Staff called Terri Ford who agreed to speak with the LPA over the phone and have a designee sign on her behalf.

Although this incident took place on 08/20/2023, Licensing did not receive an LIC 624 until 08/23/2023. This is in violation of reporting requirements. Whenever there is an incident of assault or abuse Licensing must receive a faxed LIC 624 and an SOC 341 within 24 hours. If for some reason a fax cannot be sent, then the Licensee should call the main office and ask to speak with the LPA/worker of the Day.

According to California Code or Regulations, Title 22 Division 6, a deficiency has been observed and cited on the LIC 809 D page.

A copy of this report was provided along with Appeal Rights to the Designee.