Complaint·January 26, 2026

(Cont. from LIC 9099) During the investigation the Department established the following sequence of events. On January 25, 2025, facility staff reported to family and responsible parties, the facility was having an Influenza A outbreak within its staff and residents. According to an outside source interview, on January 26, 2025, R1 was noticed to have a cough, and such was reported to Staff 1 (S1). Interview with S1 revealed that R1’s Primary Care Provider (PCP) was faxed with details of the symptoms and S1 was later contacted by the PCP via telephone stating that they were unable to provide care to R1 and to contact another provider. Records and interviews collected revealed that on January 27, 2025, an outside sourced medical provider (OS1) visited R1 for other services and noted that R1 was having a cough, OS1 proceeded to report such to S1, S1 informed OS1 that this had already been reported to the medical provider. On January 28, 2025, R1’s responsible party contacted the facility and was informed R1 had not received medical care for symptoms. Responsible party proceeded to contact a medical provider and schedule a video visit with R1 for the next morning, January 29, 2025. During the video appointment, the medical provider advised the responsible party and facility staff to contact emergency medical care immediately. Medical records collected established that after being admitted to the hospital, R1 was diagnosed with Influenza A and acute hypoxic respiratory failure. Further interviews revealed that no staff communicated with the resident, or responsible party regarding response from the first medical provider and did not provide additional medical care to R1 between January 26, 2025, until January 29, 2025, therefore medical care was delayed. Based on interviews conducted, review of records, including outside sources records, a preponderance of evidence exists to support the allegation. Therefore, the allegation is substantiated. A deficiency is cited per the Health and Safety Code (refer to the attached LIC 9099-D). The Department has determined this violation resulted in hospitalization to resident in care. An immediate Civil Penalty of $500.00 is charged and is noted on the LIC421IM. Currently, according to Health and Safety Code Section 1569.49, an additional civil penalty assessment is under review by the Program Administrator of Community Care Licensing Division. An exit interview was conducted with Executive Director Tia Suuronen-Goodwin, and a Plan of Correction was jointly developed. A copy of this report, LIC811, LIC 9099-C, LIC 9099-D, and the Licensee/Appeal Rights (LIC 9058) were provided to Executive Director Tia Suuronen-Goodwin, signature on this form confirms receipt of documents.