Follow-up·February 28, 2025

Licensing Program Analyst (LPA) Kathleen Banrasavong arrived unannounced to the facility to cite for a case management deficiencies, on a visit regarding the health, safety, and welfare of residents in care. During the Department's investigation for complaint control number #18-AS-20240515085438 . The Department discovered that the facility failed to submit a serious incident report to the department. The Facility failed to show proof that there was any attempts made to notify the department of the incident where R1 had a fall on 08/13/22 and went to the hospital. Executive Director, Tammy Eddy stated to LPA Banrasavong the facility had no record of the incident via email correspondence, of any proof of any Serious Incident Reports (SIRS) submitted to Licensing. This is a violation of Title 22 Regulations Reporting Requirements. LPA toured the facility and observed all facility utilities to be on and operating without issues. Food supply is sufficient. There is no immediate concern for residents in care at this time. There is one (1) deficiencies being cited, per California Health & Safety Code and Code of Regulations, Title 22, Division 6. An exit interview was conducted, a copy of this report, the 809-D, an 811, and appeal rights were provided to the Executive Director, Tammy Eddy.