Non-compliance follow-up·January 30, 2025

On January 30, 2025 at 12:30 PM, Licensing Program Analyst (LPA) James Sampair conducted an unannounced case management visit to follow up on multiple substantiated allegations. LPA met with Caregiver Marvin Misa and explained the purpose of the visit. On May 9, 2024, the Department concluded a complaint investigation and substantiated the following five (5) allegations while a resident (R1) was under care: severe malnutrition, severe dehydration, developing pressure injury, developing a Urinary Tract Infection (UTI), and staff not seek medical attention in a timely manner. The Licensee was cited for violating the Health and Safety Code (HSC) Section 1569.269(a)(10) Enumerated Rights; California Code of Regulations (CCR), Title 22, Section 87464(f)(1) Basic Services, CCR, Title 22, Section 87615(a)(1) Prohibited Health Conditions; CCR, Title 22, Section 87466 Observation of the Resident; and CCR, Title 22, Section 87465 (a)(1) In cidental Medical and Dental Care. At the time of the complaint visit on May 9, 2024, an immediate civil penalty of $500 was issued. The licensee was informed that an additional civil penalty was still being determined and might be assessed based on Health and Safety Code § 1569.49. Continued on LIC 809-C . . . . . . Continued from LIC 809 The Department concluded an analysis and has determined that a civil penalty is warranted for serious bodily injury. Per Welfare and Institutions Code § 15610.67, serious bodily injury is defined as “an injury involving extreme physical pain, substantial risk of death, or protracted loss or impairment of a function of a bodily member, organ, or of mental faculty, or requiring medical intervention, including but not limited to, hospitalization, surgery, or physical rehabilitation.” This is evidenced by the licensee’s failure to protect R1 from severe neglect which resulted in severe malnourishment and weight loss. R1 had an unstageable right ischial tuberosity pressure injury and was retained at the facility without proper medical care being provided. In addition, facility staff failed to provide adequate fluids to R1 which resulted in R1 being hospitalized for severe dehydration. R1 was severely dehydrated which contributed to R1 developing a UTI. Staff neglected to arrange and or assist in arranging appropriate medical care to the severe medical conditions and needs of R1. Today, January 30, 2025, the Department will be issuing a civil penalty per Health and Safety Code § 1569.49 for a violation that the Department constitutes as serious bodily injury in the amount of $10,000. However, since an immediate civil penalty of $500 was previously issued on May 9, 2024, the amount of the civil penalty today will be $9,500. A copy of the LIC 421D was given to Marvin Misa and originals were signed. Exit interview conducted. A copy of the report issued. Appeal Rights provided. Marvin Misa's signature on this report acknowledges receipt of the Appeal Rights, found on page two of LIC 421D.