complaint·July 13, 2022

Regarding the allegation: Facility did not meet reporting requirements On 07/11/2022, it was alleged that the facility did not report Resident #1’s (R1’s) death to Resident #1’s responsible party. On 06/30/2022, R1 passed away and the facility contacted R1’s Hospice Agency. On 07/01/2022, the facility sent R1’s death report (LIC 624A) to Community Care Licensing (CCL). On 07/11/2022, the Administrator and Business Office Manager contacted R1’s responsible party via email to coordinate the removal of the R1’s personal property. However, no phone call or a written report was submitted to the person responsible for the R1 within seven days of R1’s death. Interviews with staff and the Administrator revealed that R1’s Hospice agency contacted person responsible for R1 about R1 death. Interview with the Administrator revealed that the Administrator assumed that staff at the facility had already contacted person responsible for R1. During the time of R1’s death, the Administrator was on personal time off and was not physically at the facility. Furthermore, R1’s death report (LIC 624A) did not include or specify the person notified about R1’s death. The Administrator explained the miscommunication that occurred and explained that going forward the Administrator will ensure that the facility is in compliance with all required reporting requirements. Based on the information gathered, the above allegation is deemed Substantiated at this time. The following deficiency was observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted and report reviewed with the Administrator. A copy of report and appeal rights will be provided via email.