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25 | Licensing Program Analyst (LPA), Angela Panushkina, conducted a CASE MANAGEMENT visit at this facility to issue deficiency in conjunction with complaint control no.: 31-AS-20230605162033 and met with Amorlina Comedia, Staff #1 (S1). Administrator arrived shortly after and LPA explained the reason for the visit.
LPA conducted a physical plant walk through, at approximately 8:20 AM, to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22, Division 6. At 8:50 AM, LPA conducted an interview with one (1) staff members and two (2) out of four (4) residents. LPA also requested five (5) resident files, and three (3) staff files and obtained copies of pertinent documents relevant to the investigation. Upon review of documents LPA observed the following:
- Incident occurred with R1 on 05/25/23 and an Incident Report (LIC624) was never submitted to the Community Care Licensing Department (CCLD) in a timely manner. Based on Title 22 Regulation: a written Unusual Incident / Injury Report shall be submitted to CCLD within seven (7) days of occurrence.
- Facility is approved for one (1) hospice waiver and there are currently three (3) hospice residents
- One (1) hospice resident has (3) 1/2 bed rail and one (1) non-hospice resident has full bed rail. LPA did not observe doctor orders on file for the bed rails.
- A Staff #2 (S2) was hired to work today without having proper documentation and or fingerprints.
Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are cited and noted on LIC 809D.
Exit interview conducted. Appeal rights explained. Copy of this report signed and delivered. |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
06/13/2023
Section Cited
CCR
87211(a)(1)A,B&D
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7 | 87211(a)(1) A,B & D Reporting Requirements
(a) Each licensee shall furnish to the licensing agency such reports... (1) A written report shall be submitted to the licensing agency and to the person... ... any of the events specified in (A), (B) & (D)...
This requirement is not met as evidenced by: | 1
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7 | Licensee shall ensure a written report is submitted to the licensing agency and to the person responsible for the resident within seven (7) days of the occurrence of any of the events. Copy of the training materials and certificates, for all staff members, shall be submitted to LPA by POC date. |
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14 | Based on interviews and record reviews, the licensee did not comply with the section cited above by failing to notify CCLD regarding the incident that occured om 05/25/23, which posed/poses a potential health and safety risk to persons in care. | 8
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Type B
06/13/2023
Section Cited
CCR87632(a)(1)
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7 | 87632 Hospice Care Waiver: (a) In order accept or retain terminally ill residents and permit them to receive care from a hospice agency... (1) Specification of the maximum number of terminally ill...
This requirement is not met as evidenced by | 1
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7 | Licensee agreed to submit a hospice exception for two (2) residents. Proof of the exception letter will be emailed to LPA by POC date. |
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14 | Based on record review the licensee did not comply with the section cited above by addmiting three (3) hospice residents, when theh facility is only approved for one (1). This poses/posed a potential health, safety or personal rights risk to persons in care | 8
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Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
06/07/2023
Section Cited
CCR
87608(a)(5)(B)
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7 | Postural Supports: (B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies...
This requirement is not met as evidenced by: | 1
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7 | Licensee agreed to remove R4's bed rail immediately, and proof of picture will be submitted to LPA by POC date. |
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14 | Based on interview and record review, the licensee did not comply with the section cited above by admitting a non-hospice resident (R4) and providing a full bed rail without a doctors approval, which poses an immediate health, safety or personal rights risk to persons in care. | 8
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Type A
06/07/2023
Section Cited
CCR87355(e)(b)(1)
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7 | Criminal record clearance: (e) All individuals subject to a criminal record review...(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance...
This requirement is not met as evidenced by: | 1
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7 | Licensee agreed to complete S2's fingerprints and associate a staff member to the facility. Copy of proof will be submitted to LPA by POC date.
Civil penalty assessed. |
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14 | Based on interview and record review, the licensee did not comply with the section cited above by hiring one (1) staff member (S2) on 06/06/23 without fingerprint clearance, which poses an immediate health, safety or personal rights risk to persons in care. | 8
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