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-20260313091002). The purpose of the visit is to issue a citation for deficiencies observed during the investigation.

During the investigation, it was revealed that Resident #1 (R1) was admitted to the facility on 07/19/2024. A review of R1’s admission agreement indicated that the responsible party signed the agreement on 09/05/2024, which is beyond the required seven (7) days following admission. Additionally, the admission agreement is missing the signature and date of the Licensee and/or Administrator on the last page.

Furthermore, during the facility tour, the LPA observed that Resident #2’s (R2’s) bed had full bed rails. A review of R2’s physician’s report dated 06/20/2024 indicates that R2 lacks the capacity for self-care. Staff interviews revealed that R2 was previously on hospice but has since been discharged and is no longer receiving hospice services. As of today, R2 is not on hospice care, and there is no approved exception request on file with the Department. R2's family stated that there is an appointment scheduled for R2 to see if they qualified for hospice services this week.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited. (refer to LIC 809-D)

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