Follow-up on corrections·December 8, 2025

Licensing Program Analyst (LPA) Valeria Conway conducted an unannounced visit at the facility in conjunction with a complaint investigation that occurred today. LPA met with Administrator, Sophia Bonoan, and explained the purpose of the visit. Entrance interview conducted. During today’s facility tour and record review conducted with the Administrator, the LPA observed that Resident’s #1(R1’s) file, with an admission date of 11/01/2025, did not contain all required on-boarding documentation. Specifically, the pre-admission appraisal form, a reappraisal form, or an appraisal/needs and service plan. The administrator stated that R1 was referred by the hospital and believed it was not necessary to complete a pre-placement assessment on R1 prior to admission. Regarding the appraisal and the appraisal/needs and service plan, the administrator explained that R1 had a short stay at the facility due to health complications, and the facility did not have sufficient time to complete these documents. Additionally, it was noted that the facility did not notify Community Care Licensing (CCL) of an apparent fall incident or of a 911 emergency response in which R1 was transported to the hospital. According to the administrator, on 11/01/2025, Resident #1 (R1) slid from their bed; however, the caregiver on duty cushioned the fall with one of their feet. The facility notified R1’s family member, who declined to have emergency services contacted. On 11/04/2025, R1 received an Xray due to ongoing discomfort and pain. On 11/30/2025, R1 was subsequently transported to the hospital via Emergency Services due to an apparent Urinary Tract Infection (UTI). When LPA inquired about the details of the fall, the administrator stated they were not present when the fall occurred. Continued on LIC 809-C Continued form LIC 809-C The administrator confirmed that they contacted 911 on 11/30/2025 after observing blood in R1’s urine. Regarding notifying CCL of these events, the administrator stated that they are aware of the CCL reporting requirements, however, because they believe this incident did not occur as a result of facility neglect, they did not believe that it was necessary to report it to CCL. LPA explained to the Administrator that a written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence Furthermore, the LPA requested R1’s plan of care from the hospice agency. According to the administrator, the hospice nurse maintains all notes and the plan of care for R1 in their office. At 10:10 A.M., the hospice nurse was contacted by phone and was asked to email the notes and plan of care to the LPA by noon. The nurse stated that the office was closed at that time and that the documents would be emailed by the end of the business day. As a result, the LPA was unable to obtain these documents during today’s visit. The LPA explained the importance of having required documents readily available and accessible at all times. Pursuant to Title 22 of the CA Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (refer to LIC 809-D). Administrator was informed that failure to correct the deficiencies may result in additional civil penalties. Exit interview conducted, today's reports, civil penalties and appeal rights were reviewed and issued.