Incident investigation·December 8, 2021

Licensing Program Analyst (LPA), Kristina Ryan, conducted an unannounced case management visit to follow up on an incident report received on December 7, 2021. LPA Ryan introduced herself, stated the purpose of the visit, was allowed entry and met with Executive Director, Sheryl Johnston and Resident Care Director, Joan Gomez. Community Care Licensing (CCL) received an incident report on December 7, 2021, regarding a resident having a witnessed fall on October 5, 2021. During today's visit, LPA toured the facility, reviewed resident records, and interviewed staff and residents. Based on interviews and record review, the licensee did not submit an incident report within seven days of a serious injury of a resident to the licensing agency. A deficiency is being cited pursuant to Title 22, Division 6, Chapter 8 of the California Code of Regulations and is listed on an LIC 809-D. An exit interview was conducted, and a plan of correction was jointly made with the licensee. A copy of the report, LIC 809-D, and Licensee/Appeal Rights (LIC 9058 01/16) will be emailed to the licensee following the visit. Acknowledgement of receipt of the documents is requested upon receipt