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-20240118100032). The purpose of the visit is to issue a citation for a deficiency observed during the initial complaint investigation.

During the visit on 08/01/2024, interviews conducted with the administrator and staff revealed that Resident #1 (R1) moved into Room #3 when they were admitted to the facility 04/26/2022 and stayed in the same room until they expired on 01/16/2024. Per R1’s physician’s report, dated 04/25/2022, it lists R1’s ambulatory status as bedridden. However, the facility has an approved fire clearance to have one (1) bedridden resident in bedroom #5 only. Additionally, per report, it states R1 had dementia upon admission to the facility and R1 did not have an updated yearly medical assessment and reappraisal as stated per regulation.

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