Facility Evaluation Report

Licensing Program Analyst (LPA) Valeria Conway conducted an unannounced CASE MANAGEMENT- DEFICIENCIES visit to this facility and met with, Laila Landu Kulungu - facility representative. The case management visit is being conducted due to deficiencies observed during the investigation of complaint control # 29-AS-20240823160942.

Based on observations, interviews and file review, LPA discovered the Licensee did not submit a written death report for Resident 1 (R1) and an incident report for Resident 2 (R2). At 10:45 A.M., LPA interviewed facility Staff #1 (S1) who stated that R1 passed away a couple of months ago. In May 2024, R2 was taken to the hospital for a thumb infection while in care. After reviewing resident's folders and the facility's e-file under Community Care Licensing (CCL) Regional Office (RO), LPA discovered that since licensure, facility has not submitted any incident reports nor death reports to CCL. LPA advised that within seven days (7) of a death, a written report shall be submitted to Community Care Licensing (CCL). Administrator did not notify CCL within the required time frames.

Interviews with facility representative and administrator reflected that facility administrator does not come to the facility often due to distance. Administrator stated that she visits the facility once in a while. Additionally, it was revealed that the facility representative acts as the facility administrator and is the administrator for all of the sister facilities located in Thousand Oaks and Camarillo.