Complaint·August 6, 2025

Continued from LIC9099, dated 8/6/2025.. Per review of hospital records provided to the LPA, R1 went out by 911 to the hospital on 12/19/23 for abdominal pain, 3/23/2024 for a fall resulting with a head injury, and on 5/27/25 for a fall resulting in a fracture. Resident had been hospitalized and receiving medical care for the fracture; Resident passed in the hospital 6/2025. Per facility file review, and department record review, there were no written reports to the Department regarding the above listed dates of resident incidents, 12/19/23, 3/23/24, and 5/27/25, including a report of the passing of R1, 6/2025, as required. There was sufficient information obtained to support that a violation had occurred regarding the allegation. The investigation, review of records, and interviews with staff, and other parties, finds that the facility failed to report incidents to the department as required by regulation. This deficiency will be cited, Reporting Requirements 87211(a)(1)- Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D). This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case, see LIC9099. The LPA reviewed regulation 87211 Reporting Requirements, with the Licensee/Administrator Monicah,Gacegu, and the importance of compliance with this regulation at all times. Licensee/Administrator stated their understanding of the above. The preponderance of evidence standard has been met, therefore the allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is being cited. Failure to correct deficiencies by due dates, may result in additional deficiency citations and/or civil penalties being assessed. Exit interview conducted with the Administrator Monicah Gacegu. Appeal Rights Provided.