Follow-up·October 5, 2022

On 10/5/22 at 9:10AM, Licensing Program Analyst (LPA) C. Lin conducted an unannounced case management visit as a result of receiving self-reported incident dated 09/29/22 submitted to CCLD regarding resident sustained injury while in care. LPA explained the purpose of the visit with administrator (ADM). Upon entry, LPA went up to the 3rd floor and tested the egress door. LPA observed that the egress door alarm went off 30 seconds before opened when being pushed, and the alarm was loud enough to be heard throughout the building. ADM investigated the incident and stated that staff didn't respond timely when the alarm going off that resulted the resident in wheelchair was able to exit out to the stairway, wheeled down the stairway from the 3rd floor to the middle session where between the 3rd and 2nd floor, and injured. ADM stated that the responsible staff was suspended immediately after the incident occurred. Suspension letter from HR was provided. At a later time, ADM stated that the responsible staff was terminated as of today. LPA observed that the subject resident's most resent physician's report (LIC602) was dated on 11/18/2019. During visit, LPA randomly reviewed 3 memory care residents' LIC602 and observed that 2 out of 3 LIC602 were not updated yearly. Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC809 D. Failure to submit proofs of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties . A $500 immediately Civil Penalties is assessed on this day. Civil penalty determination related to serious bodily injury is pending. Exit interview conducted with ADM. LIC809D, LIC421M, Appeal Rights, and a copy of this report provided.