Follow-up·March 28, 2025

Licensing Program Analyst (LPA) Jill Nakagawa arrived on March 28, 2025 for an unannounced Case Management visit to follow up on self-reported incident submitted to Community Care Licensing on June 14, 2024. LPA met with Maria Burton and explained the purpose of the visit. On July 1, 2024, the Department conducted a Case Management visit to follow up on a self-reported incident submitted to Community Care Licensing on June 14, 2024. The Department has concluded an analysis and has determined that a civil penalty is warranted for serious bodily injury. The Welfare and Institutions Code Section §15610.67 defines serious bodily injury as "an injury involving extreme physical pain, substantial risk of death, or protracted loss or impairment of a function of a bodily member, organ, or of mental faculty, or requiring medical intervention, including but not limited to, hospitalization, surgery, or physical rehabilitation.” This is evidenced by the facilities lack of supervision on June 11, 2024, when R1, who was identified as not being able to leave the facility unassisted, was found at approximately 4:50 a.m. outside the facility in the parking lot on the ground with a wheelchair upside down next to them. R1 sustained a pelvic fracture and required hospitalization. Today March 28, 2025, the Department is issuing a civil penalty per Health and Safety Code §1569.49 for a violation that the Department constitutes as serious bodily injury resulting in the hospitalization of a resident, in the amount of $10,000. Exit interview conducted. A copy of the report has been issued. Appeal rights provided. Facility representative and signature on this report acknowledges receipt of the appeal rights, found on page two of LIC 421D.