Follow-up·October 12, 2022

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced case management visit to the facility. LPA Lopez identified herself and was granted entry by Frederick Locsin, Administrator. LPA stated the purpose of the visit and reviewed the basic elements of the visit with Administrator Locsin. Licensee Donnah Locsin was contacted via telephone. The facility self-reported an incident regarding resident #1 (R1) (See LIC 811 Confidential Names List) to Community Care Licensing on October 11, 2022. The facility reported that on October 11, 2022, R1 was sent to the hospital for a noted injury. During today’s visit, LPA spoke with staff and requested resident records. This case management does need further follow-up and may require additional visits or phone calls. No deficiencies were cited during this visit. An exit interview was conducted with Licensee Locsin and Administrator Locsin and a copy of this report, LIC 811 and Licensee/Appeal Rights (LIC 9058 3/22) were provided to the Administrator at the conclusion of the visit. The signature below confirms the documents were received.