Non-compliance follow-up·April 7, 2025

On 04/07/2025, Licensing Program Analyst (LPA) Chris Arnhold met with Administrator Valesia Cole for an unannounced inspection to follow up on substantiated complaint allegations; complaint number 21-AS-20231121111127. On February 29, 2024, the Department concluded an investigation which alleged that due to neglect, resident sustained multiple pressure injuries and due to staff negligence, resident sustained a leg wound infection. The licensee was cited for violating California Code of Regulations (CCR) Title 22, § 87466 Observation of the Resident and 87468.1(a)(8) Personal Rights of Residents in All Facilities. On May 15, 2024, during a meeting via Zoom the licensee was informed that a civil penalty might be assessed based on Health and Safety Code §1569.49. The Department has concluded an analysis and has determined that a civil penalty is warranted for serious bodily injury. Continued on LIC809-C... Per Welfare and Institutions Code §15610.67 defines serious bodily injury 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 facility not providing adequate care and supervision that resulted in hospitalization a left heel unstageable pressure injury and an infection of the wound . Today, 04/07/2025, the Department is 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. Exit interview conducted.  A copy of the report issued.  Appeal rights provided. Valesia Coles' signature on this report acknowledges receipt of the appeal rights, found on page two of LIC 421D.