Facility Evaluation Report

Licensing Program Analyst (LPA) Valeria Conway conducted a Case Management - Incident visit regarding a self-reported incident. At 1:00 P.M., LPA met with Executive Director (ED), Michele Johnson, and explained the reason for the visit. Entrance interview conducted.

On 04/30/2026, the Woodland Hills North Adult and Senior Care Regional Office (RO) received an incident report regarding Resident #1 (R1). The self-reported Unusual Incident/Injury Report (LIC 624) indicated that on 04/25/2026, R1 was unable to transfer or bear weight and was observed with increased swelling on their left leg. R1 was subsequently transported to the hospital on 04/25/2026, where they were treated for a left hip fracture. Interviews conducted with staff revealed that while R1 was in the activities area "rotunda", R1 reportedly slipped from their wheelchair. Staff stated that by the time staff attempted to prevent the fall, R1 was already on the ground. Staff further reported that while paramedics were assisting R1, R1’s Power of Attorney (POA) arrived at the facility and refused transportation of R1 to the hospital. LPA did not receive a LIC 624 form regarding the unwitnessed fall that reportedly occurred on 4/24/2026. Information pertaining to the circumstances surrounding R1’s injuries was not provided to the Department within the required 7-day time frame and only because the LPA emailed the Resident Care Director, Erika Miller, on 05/26/2026, requesting additional information. LPA also discussed hospice reporting requirements with he ED.

During today’s visit the LPA explained the importance of reporting to CCLD within the required time frame. Based on the information obtained, the facility is cited for late reporting.

Exit interview, report given, deficiency cited on 809-D, appeal rights given.