Health check·February 7, 2023

Licensing Program Analyst (LPA) Renee Campbell arrived unannounced to conduct a Case Management visit on 2/6/23 at 11:30 am. The visit was regarding a fall incident that occurred on 02/02/2023. LPA met with Mohamed Massaquoi and stated the purpose of the visit. LPA requested to see the appraisal, the reappraisal if appropriate and the 602 and reviewed the IR. Records show that the resident had no wandering behaviors upon admission but needed moderate assistance when toileting, or when transferring to and from the bed. After the fall, the administrator had not yet done the reappraisal as of 02/07/2023. In regards to the night of the incident, the administrator clarified that the two staff on shift during the incident called both the Administrator and 911 at approximately the same time. LPA Campbell has requested call logs to confirm. Per the administrator, the resident will use a bed alarm in addition to bed checks every two hours to prevent further falls. He will also be present and awake in the facility until midnight when the overnight shift arrives. Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 6, the following deficiencies are being cited on the attached 809D during this visit. If any of the cited deficiencies are not corrected by the noted due dates; civil penalties may be assessed. The Administrator was provided a copy of their rights (LIC9058) and their signature on this form acknowledges receipt of these rights. An exit interview was conducted, a copy of the report was given.