Facility Evaluation Report

Licensing Program Analyst (LPA) Teresa Camara conducted a case management - incident visit to the facility regarding a late death report for resident 1 (R1). LPA initially met with staff 1 (S1) and the administrator Johnna Udden arrived at the facility at 12:45 p.m.

Interviews were conducted with S1 at 12:23 p.m. and staff 2 (S2) at 12:29 p.m. LPA requested records for R1 but they are no longer at the facility. The administrator brought the records to the facility and LPA reviewed the records at 12:48 p.m.

Records show that R1 started their most recent admission to hospice on 4/6/2023. However, the administrator did not notify Community Care Licensing (CCL) of R1 starting hospice. Regulations require the licensee notify CCL within five working days of residents starting hospice or a hospice resident being admitted to the facility.

Records show that R1 passed away on 5/7/2023, however the administrator did not report R1's death to CCL until 7/26/2023. Regulations require that the death of a resident is reported to CCL within seven days of the occurrence.

Pursuant to Title 22, California Code of Regulations, the following deficiency will be cited (refer to LIC 809-D)

Exit interview conducted, citations issued, appeal rights discussed, and a copy of this report sent via email.