Incident investigation·February 13, 2024

This unannounced Case Management – Incident inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of a health and safety check and to follow up on a self-reported incident report received in the Orange County Regional Office (OCRO) on 01/30/24 regarding an incident involving Resident #1 (R1). LPA met with Administrator (AD) Miguelito Fajardo and discussed the purpose of the inspection. During today’s inspection, LPA toured the facility with AD and observed 2 staff and 6 residents present. LPA conducted health and safety checks on the residents present and observed no health and safety issues. LPA observed the facility to be clean and organized and found no health and safety issues. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations, the electricity and water were running, the facility had soap and paper towels, and the medications, sharps, and toxins were properly stored. LPA interviewed AD and requested and reviewed copies of the resident roster, staff roster, R1’s resident file, R1’s Kaiser Medical Records dated 01/16/24, and R1’s Kaiser Medical Records dated 01/27/24. Per AD, on 01/13/24 at 12:20AM, R1 had an unwitnessed fall. R1 was assisted by staff and assessed by AD and reported no pain. While facility staff were trying to transport R1 to urgent care on 01/13/24 at around 2PM, R1 complained of a high level of pain and could not be transported due to the pain, so 9-1-1 was called around 3PM. Per Kaiser Medical Records dated 01/16/24 and 01/27/24, R1 was later diagnosed at the hospital with multiple rib fractures. The facility did not obtain medical attention timely for R1. Based on the information obtained during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. A technical violation regarding resident records is also being issued. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.