complaint·October 23, 2025

The investigation revealed the following: Regarding the allegation, " Staff has inadequate record keeping", it is being alleged that the facility does not include important information regarding an incident that has occurred to a resident in care. Interviews revealed the following: four (4) out of seven (7) staff have confirmed that a resident was observed, after a fall, on the right hand side of their body, while three (3) staff were not familiar how the resident was observed after this fall. Hospice notes were observed, which indicated that there were no abnormal vitals recorded on 09/16/25, 09/17/25 and 09/26/25. Notes from staff at the facility have been recorded during the time period of 04/11/25 through 10/04/25, no abnormalities of documentation has been observed. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. The investigation revealed the following: Regarding the allegation, " Staff did not properly follow reporting requirements", it is being alleged that the facility has not submitted a special incident report (LIC624) within California's required timeline. Upon receiving the LIC624, lpa reviewed the dates recorded on the LIC624. Per title 22 regulation, a facility is to submit a written report within seven (7) days after the occurrence of an injury to any resident(s) in care. The injury took place on 09/15/25, leaving until 09/22/25 for the facility to submit LIC624; whereas the report was not submitted to CCL until 09/34/25. Interviews revealed that four (4) out of seven (7) staff were not accurate of the requirements to report incidents to Community Care Licensing (CCL) division following an injury. Furthermore, S1 confirmed that the facility has not reported this incident to CCL in a timely manner. Based on record reviews and interviews conducted, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be Substantiated . California Code of Regulations, Title twenty-two (22), Division six (6) is being cited on the attached LIC 9099D. One deficiency has been cited during today's visit. An exit interview was held with staff one, Paul Gozon - Executive Director (S1) and a copy of this report, citation(s) cited and facilities' appeal rights have been provided to S1.