Facility Evaluation Report

Licensing Program Analyst (LPA) Martha Arroyo conducted a Case Management - Deficiencies visit in conjunction with a complaint visit (Complaint Control # 29-AS-20250819122802). The purpose of the visit is to issue citation for a deficiency observed during the investigation.

During the course of the investigation, a review of records and interviews conducted revealed that Resident #1 (R1) experienced numerous falls while residing at the facility. The unwitnessed fall, combined with altered mental status, resulted in staff calling 911 and/or hospitalization on 06/20/2025, 07/11/2025, 08/06/2025, 08/12/2025, and 08/15/2025. However, a review of records indicated that a written Unusual Incident/Injury Report (LIC 624) was not submitted to Community Care Licensing (CCLD) within seven (7) days of each occurrence, as required by reporting regulations.

The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties.

Exit interview was conducted. A copy of the report and appeal rights were provided.