Facility Evaluation Report

On 10/24/2024, Licensing Program Analysts (LPAs) Walton and Salazar arrived unannounced to conduct a case management inspection. LPAs introduced themselves, stated the purpose of the visit and requested to meet with the Administrator. LPAs met with Client Care Coordinator, Jaylyn Johnson. Administrator, Jessica Mata, arrived a short time later.

During the investigation for complaint number 24-AS-20241017090403, LPAs found that the 3 out of 3 dining chairs were in need of cleaning. LPAs also observed the adaptive chair, in the dining area, was in disrepair and observed to have holes in the side arms exposing the chair filing. The adaptive chair was also in need of cleaning.

During today's inspection, LPAs conducted a file review for residents in care. Upon review of records, LPAs found that the facility did not report an incident that occurred on 08/05/2024, when R1 was given "an extra LINZESS" when the medication had already been administered at 5:40AM. Facility staff contacted the primary care physician and informed to monitor. On 08/28/2024, the facility did not report when R1 was transported to the emergency room.

Further review of records revealed that the facility did not report that on 10/17/2024, R2 was taken to Urgent Care due to "wheezing" and facility staff was advised to take R2 to the emergency room for additional testing.

Deficiencies are being cited in accordance to California Code of Regulations, Title 22, Division 6 on the attached 809D.

Exit interview and a plan of correction was reviewed and developed with Administrator. A copy of this report and appeal rights were discussed and provided to Administrator, Jessica Mata, whose signature on this form confirms receipt of this document.