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25 | Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to deliver findings to a complaint received on 4/11/2022 under the current license at the location. LPA met with Diane Evering, caregiver LPA spoke to Administrator and Licensee by phone.
Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the community. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N95 mask.
The Department investigated the allegation, "Not enough staff to supervise residents" on 3/3/22 when a resident (R1), who had a diagnosis of Dementia, left the facility unassisted and (3) other residents (R2, R3 and R4), one of whom also had a diagnosis of Dementia, were left unattended while the only staff (S1) on duty left the facility to locate R1 and return her to the facility. Interviews conducted with residents who were left unattended confirmed that S1 was gone for the facility for approximately an hour and there were no other staff on site to provide supervision. Additionally, the AWOL violation was not reported timely to the Department until 4/16/22 after it was discussed.
Due to the current license (#345002868) not being issued until 3/9/2022, following the AWOL on 3/3/2022, the following citations are being issued under this closed license to document the violations.
Per California Code of Regulation, Title 22, Division 6, Chapter 8, the following (3) deficiencies are being issued on LIC809D. There is also an immediate civil penalty being issued today.
Exit interview. Copy of report and appeal rights provided.
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Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
08/05/2022
Section Cited
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7 | 87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (4) There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her current appraisal. This requirement is not met as evidenced by: |  | |
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14 | Based on interviews conducted, the Licensee did not ensure that resident (R1) was unable to leave the facility unassisted, on 3/3/22, which posed an immediate health and safety risk to residents in care. | 8
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14 | LIcensee has since installed additinal outside cameras since the AWOl occurred. |
Type A
08/05/2022
Section Cited
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7 | 87411 Personnel Requirements - General-
(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This requirement is not met as evidenced by: | | |
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14 | Based on interviews conducted, the Licensee did not ensure that residents (R2/R3/R4) were provided with supervision during the time (approx hour) when the only staff on duty (S1) left the facility on 3/3/22 to locate another resident (R1) who had left the facility unassisted, which posed an immediate health and safety risk to residents in care. An LIC624 was not submitted to the department until 4/16/22 after it was requested. | 8
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14 | *Also an immediate civil penalty in the amount of $500 is being issued to the absence of supervision on 3/3/22. |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
08/05/2022
Section Cited
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7 | 87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement is not met as evidenced by:
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14 | Based on interview conducted with the Administrator/Licensee and documentation reviewed, the Licensee did not ensure that the incident from 3/3/22 when resident (LOis) left the facility unassisted was reported timely to the Department, which posed a potential health and safety violation to residents in care. | 8
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