Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek conducted an unannounced visit at the facility in conjunction with an investigation of complaint control # 29-AS-20240912104318.

During the investigation, LPA observed deficiencies unrelated to the complaint allegation. Review of Resident #1 (R1)’s documents revealed that R1 had moved into the facility on 07/07/2023, at which time R1 had a physician’s report and service plan. On 01/12/2024, R1’s physician filled out a new physician’s report and R1 was admitted to hospice care on this date. Although R1 had a change of condition as evidenced by qualification for hospice care, the facility did not complete a new service plan at that time. Additionally, R1 was hospitalized on 09/05/2024 and was released back to the facility 2 (two) days later, however, no new service plan was completed at that time either.

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

Exit interview conducted, today's reports and appeal rights were reviewed and issued.