Follow-up·April 21, 2023

Licensing Program Analyst (LPA) Cuadra arrived unannounced to the facility met with Administrator Shannon Brown to conduct a case management visit to follow up and cite deficiencies discovered during complaint investigation. During today’s visit, LPA is following up on a death report received at CCL on 2/7/2023. Per death report, on 1/9/23 resident (R2) who resided in the independent living section of the facility. R2 was found outside in the bushes by another resident, who notified staff and they called Emergency Personnel that transported R2 to the Hospital. R2’s responsible party were notified. However, LPA inquired with San Rafael Police Department and it was revealed that law enforcement was not contacted about the incident. LPA was informed that 911 was contacted, LPA is requesting security guard contract including frequency of round checks conducted for the month of January 2023. However, this incident needs further investigation and review prior to make a final determination. LPA learned through records review and interviews with Health/Wellness Director that resident (R1) had two incidents of falls on 12/6/22 and 12/30/22 which were not reported to CCL within 7 days of incident. Also, death reports for R1 who passed away on 1/4/23 and R2 who passed away on 1/9/23 were not submitted to CCL until 2/7/23. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties