Follow-up on corrections·October 26, 2023

Licensing Program Analyst (LPA) Christine Dolores arrived to the facility unannounced to open an initial complaint investigation. During the complaint investigation, a case management - deficiencies visit was conducted. LPA met with Administrator (ADM), Nicholas Inneh. During visit, LPA was made aware of a resident (R1) who passed away. Based on interview with ADM, the resident passed away on 10/13/2023. LPA did not observe an incident report and death report was sent to the Department. LPA spoke with the Licensee, Cyril Inneh during visit who states he had faxed the incident report and death report the day after the incident. Licensee was unable to immediately provide the proof of fax during visit. The following documents were obtained to include the incident report, death report, police case number, R1's physician's report, appraisal/needs and services plan, identification and emergency information, and medical records. Licensee will submit staff's 1st Aid Certification to LPA Dolores by 1:00pm today. A deficiency was cited per California Code of Regulation, Title 22. See LIC809-D. A civil penalty of $250 will be assessed for a repeat violation within 12 months of the initial citation. If the deficiency is not corrected within 24 hours, an additional $100 will be assessed until the deficiency is corrected. See LIC421FC. This report was reviewed with Administrator, Nicholas Inneh and a copy of the report and appeal rights was provided.