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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604171
Report Date: 04/07/2023
Date Signed: 04/07/2023 11:36:10 AM


Document Has Been Signed on 04/07/2023 11:36 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:LO-HAR SENIOR LIVINGFACILITY NUMBER:
374604171
ADMINISTRATOR:DUCHARME-FRANKLIN, KANDYFACILITY TYPE:
740
ADDRESS:768 DOROTHY STTELEPHONE:
(619) 444-8270
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY:68CENSUS: 56DATE:
04/07/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Kandy FranklinTIME COMPLETED:
10:35 AM
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Licensing Program Analyst (LPA) Iby Strong conducted a Case Management Visit during an unannounced Complaint Visit. LPA met with Administrator Kandy Franklin and discussed the purpose of the visit.

During a complaint investigation, LPA discovered, through interviews and record reviews that R1 is residing within a locked memory care unit as of June 2022, though not diagnosed with a major neuro cognitive impairment. According to Physician Report dated July 7, 2022, R1 is diagnosed with mild cognitive impairment, is confused and disoriented, does not require continuous care, can leave facility unassisted, has a wandering behavior and cannot have access to personal hygiene products. Based on R1’s Individual Care Plan dated March 28, 2022, there were no updates noted after changed in condition resulting in placement in memory care unit. Records reviewed revealed that R1 did not have a relevant Individual Care Plan that identified how R1's needs would be met in locked memory care unit.

Based on this information, a deficiency is being cited Per Title 22, Division 6, Chapter 8 of the California Code of Regulations and is listed on an LIC 809-D. An exit interview was conducted and a copy of the report, Licensee/Appeal Rights (LIC9058 03/22) and LIC811 were provided to Administrator Kandy Franklin.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Iby StrongTELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:
DATE: 04/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/07/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/07/2023 11:36 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108


FACILITY NAME: LO-HAR SENIOR LIVING
FACILITY NUMBER: 374604171

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/07/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/21/2023
Section Cited

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87464 Basic Services (d)... if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs... providing the other basic services... either directly or through outside resources.
This requirement was not met as evidence by;
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Administrator agrees to create a detailed plan of care for R1 and provide to LPA by 4/21/2023.
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Based on interviews and records reviewed the licensee did not identify how facility would meet the resident's needs in 1 in 56 of persons in care which posed a potential Health, Safety, and Personal Rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Iby StrongTELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:
DATE: 04/07/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/07/2023
LIC809 (FAS) - (06/04)
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