Follow-up on corrections·April 29, 2022

Licensing Program Analyst (LPA) Martha Guzman Chavez conducted an unannounced CASE MANAGEMENT- DEFICIENCIES visit to the above facility. The LPA met with Administrator, Karina to discuss the death reporting requirement as per regulation. Entrance interview conducted. During today’s visit, documents reviewed revealed licensee did not submit a death report (LIC 624A) for Resident #1 (R1) to Community Care Licensing (CCL). On 4/18/2022 at 6:10 p.m., the Department was notified that R1 had passed away on 4/09/2022; however, an LIC 624A was never submitted. Per interviews conducted, it was revealed that Administrator had started the death report, but did not send it to CCL. The LPA advised the Administrator that death reports are required to be reported to CCL within seven (7) days of the incident(s) as required by California Code of Regulations. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted. Appeal Rights discussed. A copy of the report will be provided via email.