Follow-up·June 6, 2023

On June 6, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced case management visit to follow up on a death report that was submitted to CCLD on May 11, 2023. LPA met with Regional Vice President of Operation, Beau Ayers, Operations Specialist, Kathleen Calobeer, and Resident Care Director, Rowena Cancino and explained the purpose of the visit. The Licensee reported on May 10, 2023, Resident 1 (R1) passed away and the immediate cause of death is not disclosed. LPA requested a copy of the death certificate, however the facility was unable to provide one. The Licensee indicated that Business Office Manager, W. Sato went check on R1 after receiving a call indicating R1 needs assistance. R1 was found in his/her room unresponsive with no pulse noted. During the visit today, LPA reviewed R1's file, interviewed staff and requested for a copy of R1's death certificate. According to facility, the death certificate has still not been obtained. Based on file reviewed, R1 had a diagnosis of chronic pain syndrome, major depressive disorder, anxiety disorder, with mild cognitive impairment. In addition, according to the physician's report from 7/2021, R1 did not exhibit symptoms of aggressive, inappropriate, and sundowning behavior. Based on resident assessment from 5/4/2023, R1 did not require any assistance with ADLs from the facility. According to staff interviewed, R1 did have a change in condition, and starting showing signs of aggression, inappropriate behavior, and signs of dementia, however no re-assessment was done. In addition, although resident care notes were being updated, the Licensee failed to develop an individualized needs and service plan for R1 to address change in condition. Deficiency of the Residential Care Elderly California Code of Regulations, Title 22, Division 6 is observed and cited on a LIC809D. Failure to correct the deficiencies may result in civil penalties. This report is reviewed and discussed with Administrator; a copy of the report is provided with appeal rights.