Twin Palms

Type of visit: Case Management - Other

Licensing Program Analyst (LPA), Angela Panushkina, arrived on August 3rd, 2026, for an unannounced inspection to follow up on substantiated allegations. On February 2, 2024, the Department concluded a complaint investigation regarding the following allegations: a resident sustained a burn in care due to lack of supervision and facility staff did not seek timely medical attention for the resident. The Licensee was cited for California Code of Regulations (CCR) Section 87465(g) Incidental Medical and Dental Care and 87411(d)(5) Personnel Requirements. At the time of the complaint visit on February 2, 2024, an immediate civil penalty of $500 was issued, and the licensee was informed that an additional civil penalty might be assessed based on Health and Safety Code §1569.49(f). 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 mental faculty, or requiring medical intervention, including but not limited to, hospitalization, surgery, or physical rehabilitation.” This is evidenced by the facility not providing proper supervision and delayed medical treatment for Resident 1 (R1). R1 sustained 4% total body surface area third-degree burns to the left thigh that required surgical intervention. Continue on LIC9099-C Today, August 3rd, 2026, the Department will be issuing a civil penalty per Health and Safety Code § 1569.49(f) for a violation that the Department constitutes as serious bodily injury in the amount of $10,000. However, since an immediate civil penalty of $500 was previously issued on June 2, 2024, the amount of the civil penalty issued today will be $9,500. Exit interview conducted. A copy of the report was issued. Appeal rights were provided. John Mallon and signature on this report acknowledge receipt of the appeal rights, found on page two of LIC 421D.the state’s words, verbatim · CDSS document, Aug 3, 2026

Type of visit: Required - 1 Year

On 2/14/2026 at approximately 10:00 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced annual visit to the facility. LPA was greeted by staff member (S3) and stated the reason for their visit. The Administrator, John Mallon arrived shortly after to assist with today’s visit. Upon arrival, LPA observed two (2) staff members (S2-S3). assisting residents with their aspects of daily living. LPA observed S3 to be wearing Personal Protective Equipment (PPE) gloves while cleaning the facility. S3 stated their first day of employment was 2/14/2026 and they help lift and transfer residents. LPA’s record review of the California Department of Social Services Guardian Background Check revealed S3 to have background clearance as of 1/26/2025 but was not associated with this facility. Additional record review of the Licensing Information System (LIS) confirmed S3 was not associated with the facility. Further record review of the facility’s file revealed on 1/17/2024 they were cited for failure to associate/transfer another staff member. LPA informed the Administrator that all staff members must be fingerprint cleared and associated prior to employment. LPA asked for the census, Staff/Resident Roster and Liability Insurance. LPA conducted a physical plant tour at approximately 2:00 PM and the following was noted: The facility is a single-story building with five (5) bedrooms and three (3) bathrooms. The facility is currently occupying four (4) residents. There is a designated staff room. The facility has an approved fire clearance for six (6) non-ambulatory residents. Hospice waiver approved for one (1). (Continue to LIC 809-C) Common areas: The living room and dining room were observed to be neat, clean, and organized. The rooms were observed to be properly furnished and in good repair. The facility maintains a comfortable temperature at 70°F. LPA observed a fire extinguisher to be located near the kitchen and dated 06/28/2025. LPA observed required postings such as Long-Term Care Ombudsman, Emergency Disaster Plan, and Personal Rights to be located alongside the common areas. A working telephone was observed. LPA observed the fireplace to be covered and inaccessible to residents. Kitchen: The kitchen was observed to be clean and free from pests. Sufficient supplies of seven (7) day nonperishable foods and two (2) day perishable foods were observed. Knives/sharps were observed to be kept in a locked kitchen drawer. The cleaning solutions/toxins were observed to be kept locked underneath the kitchen sink. Kitchen appliances were observed to be working and in proper condition. Laundry Room: The laundry appliances were observed to located near the kitchen. LPA observed cleaning solutions and toxins stored appropriately within the laundry room and inaccessible to residents. The laundry appliances were observed to be in proper condition. Garage: The garage can be accessed from inside of the facility. The garage was observed to be kept locked and used for storage purposes. Extra refrigerator and freezer with additional food for residents was observed. Bedrooms: The residents’ rooms are adequately furnished with appropriate furniture and lighting system. Hallways/passageways are lighted appropriately. Extra linens/covers were observed to be stored in cabinets located within the hallway’s passageway. Staff Room: The staff room was observed to be kept locked. Bathrooms: The bathrooms were checked for cleanliness and proper operation. The hot water temperature was measured. LPA observed appropriate grab rails and slip-resistant mats to be in proper condition. Backyard: The backyard of the facility is equipped with a designated shaded area with outdoor furniture for residents. LPA observed there to be a locked non-operational pool properly fenced. (Continue to LIC 809-C) Medications: The medications along with staff and residents’ files were observed to be kept in a locked filing cabinet located in the staff room. First-aid kit observed. Smoke detectors and carbon monoxide observed to be working properly and were tested. Residents/Staff Records: LPA conducted a complete file review of resident records. Resident records appeared to be complete. Staff records: LPA conducted a complete file review of four (4) staff records. Staff records were not complete and updated. Citations issued, please refer to LIC 809-D. A civil penalty for $100 per day for a maximum of 5 days in the amount of $500 for criminal record clearance/transfer violation is being assessed on the attached LIC 421BG. There were no other immediate health and safety hazards observed during the day of inspection. Exit interview was conducted, appeal rights given and a copy of this report was provided to the Administrator.the state’s words, verbatim · CDSS document, Feb 14, 2026

The state marks this report as 7 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

At 8:30am, Licensing Program Analyst (LPA) Angela Panushkina arrived at the facility to conduct an unannounced annual inspection. Upon arrival, LPA met with Staff #1 (S1), who granted access to the facility. Administrator arrived shortly after and LPA explained the reason for the visit. At 8:45am LPA conducted a tour of the physical plant and observed the following: Kitchen: At approximately, 08:40am LPA toured the kitchen area and observed enough supplies of staple non-perishable for minimum 1 week and perishable for 2 days at the facility. All knives and sharps are observed to be locked in a kitchen drawer and inaccessible to residents. Laundry: Laundry area is located by the kitchen and all detergents were kept locked and inaccessible to residents. LPA also observed a fire extinguisher that was last purchased on 06/24/24. Medications: At approximately, 09:00am LPA observed medications are centrally stored and locked in the cabinet, in the kitchen and staff room and inaccessible to residents in care. The garage: Facility has an attached garage that can be accessed from the kitchen. LPA observed the door kept locked and inaccessible to residents. Extra supplies and food were also observed. Bedrooms: There are five (5) bedrooms designated for residents use and have sufficient lighting. All bedrooms are properly furnished, clean and have appropriate bedding and linens. Auditory alarms were tested and observed to be operational. Facility also has one (1) bedroom for live-in staff. Bathrooms: At 09:20am LPA observed all bathrooms are clean and in good repair. Properly supplied with toilet papers, soap and paper towels. Continue on LIC809-C LPA observed appropriate grab bar and had non-skid mat. All trash cans in bathrooms had fitted lids to protect from cross contamination. Common Areas: The facility maintains a comfortable temperature at 75°F. The living room and dining area appeared clean and were properly furnished. No obstructions and or tripping hazards throughout the facility. Smoke detectors/carbon monoxide. Dual smoke and carbon monoxide detectors were located throughout the facility, and at 9:25am they were tested and observed to be operational. Outside areas: At approximately, 09:30am LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for clients. LPA discussed the importance of maintaining the care and supervision to meet the needs of residents. There are no bodies of water. Between 09:40am to 11:00am, LPAs reviewed records of five (5) clients and two (2) staff. Client and staff records appeared to be complete and updated. Administrative: LPA collected Certificate of Liability Insurance, Administrator Certificate and LIC500. No citations issued during this visit. Exit interview conducted. Copy of report emailed to Licensee.the state’s words, verbatim · CDSS document, Nov 13, 2024

Type of visit: Case Management - Legal/Non-compliance

At 08:30am, Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced Case Management Visit. LPA met with Staff #1 (S1), who granted access to the facility. Administrator arrived shortly after and LPA explained the reason for the visit. On 02/29/2024, a Noncompliance Conference was held at the Regional Office (RO) with the Administrator and concerns from Complaints #31-AS-20240110162135 and #31-AS-20230605162033 were addressed. At that time, Regional Manager (RM) and Licensing Program Manager (LPM) advised the Administrator to conduct thorough pre-admission appraisals and complete staff training. The purpose of todays visit is to review all resident and staff files for an accuracy. LPA was informed that the facility currently has five (5) residents. Facility also has two (2) staff members and LPA checked the Licensing Information System (LIS) and observed that both staff members are associated with this facility and the fingerprints are cleared. Resident Files: At 9:45am team conducted resident and staff records review. The following was observed. Five (5) out of five (5) resident file were available and LPA observed all files were signed and complete. Staff Files: Administrator stated that the facility currently has four (4) staff members. LPA observed two (2) out of four (4) staff members present during today's visit. LPA conducted review of staff records and observed all required training along with staff signed and complete records on file. No deficiency cited. Exit interviewed conducted and copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Nov 13, 2024

Allegation investigated: Resident sustained a burn in care due to lack of supervision. Facility staff did not seek timely medical attention for resident.

Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced subsequent visit to this facility to deliver the final report. LPA met with Amorlina Comedia, Staff #1 (S1), who granted access to the facility. S1 contacted the Administrator and LPA explained the reason for the visit. Administrator was unable to come to the facility and designated S1 to sign the report. On 06/05/2023, the Woodland Hills South Adult and Senior Care Regional Office received a complaint regarding the allegations, “Resident sustained a burn in care due to lack of supervision" and "Facility staff did not seek timely medical attention for resident." The complaint was referred to Community Care Licensing Division’s Investigations Branch. The complaint was assigned to investigator Dennis Douglas. On 06/06/23, LPA Panushkina initiated the complaint. LPA conducted tour of the facility and obtained copies of pertinent information which include but not limited to Physician’s Report (dated 08/24/2022), Continue on LIC9099-C Substantiated Admission Agreement (dated 09/18/2022) and Appraisal Needs and Services (dated 05/01/2023). LPA conducted interviews with Administrator, one (1) out of two (2) staff members and two (2) out of four (4) residents. Investigator Douglas conducted interviews with Medical Social Worker (on 07/19/23), R1, Administrator and two (2) staff members (on 07/28/23). Moreover, on 08/23/23 the Investigator visited “West Hills Hospital Burn Center” and conducted an interview with the Chief Medical Officer and obtained Medical Records for R1. Lastly, the Investigator conducted an interview with a witness on 08/28/23. Allegation: Resident sustained a burn in care due to lack of supervision The investigation findings revealed that R1 had been living at this facility since September 18th, 2023. Although, R1 was able to communicate his/her needs and feed self, due to R1’s physical condition, R1 required assistance with the Activities of Daily Living (ADL). On 05/26/23, R1 was in bed, watching TV and facility staff served very hot soup (requested by R1) for lunch. S2 placed the hot soup on the “over the bed” tray/table (on wheels) next to R1’s bed and left the room. No staff made sure that the table was stable and R1 was in a position in which they were able to prevent the spill. When R1 went to grab the soup from the table it spilled on his/her thigh causing the burn. It was revealed that the tray/table was loose causing it to wobble, which contributed to the soup spilling. When R1 called for help, Staff #1 (S1) and Staff #2 (S2) went to R1’s room, placed R1 on a wheelchair and then cleaned the bed. Immediately, after R1 was changed/treated, the facility staff contacted the Administrator and notified of an incident. Administrator instructed them, via telephone, to put ice and ointment (aloe vera) on the wound. After the Administrator arrived to the facility and observed R1’s burn did not appear to be blistering and R1 did not complain of any pain, Administrator determined to wait for a Home Health agency that was already scheduled to come to the facility in the coming days. However, the Home Health agency did not come on their scheduled treatment date and even then, R1 was not taken to the hospital. Since R1 had also already been scheduled to see his/her primary doctor in the coming 5 days, the Administrator made a decision to wait, although by the 2nd or 3rd day, the burn began to blister. On 05/30/23, during the scheduled doctors appointment, the doctor recommended R1 be transferred to the burn center because they did not have a burn unit at that particular Kaiser facility. Once admitted to the hospital (on 05/30/23) R1 was diagnosed with large 2nd/3rd degree burn to his/her left thigh. Interview with the Chief Medical Officer revealed that R1 needed to be hospitalized for 16 days as a “skin graft” was needed to repair the damage done to R1’s thigh as a result of the burns. Continue on LIC9099-C Per the medical report, it was noted that on, 06/01/23, a debridement was performed down to the deep dermal tissue and an application of homograft cadaveric skin to the left thigh. Allegation: Facility staff did not seek timely medical attention for resident. On 05/26/23, R1 was in bed, watching TV and the facility staff served very hot soup (requested by R1) for lunch. S2 placed the hot soup on the “over the bed” tray/table (on wheels) next to R1’s bed and left the room. No staff made sure that the table was stable and R1 was in a position in which they were able to prevent the spill. When R1 went to grab the soup from the table it spilled on his/her thigh causing the burn. Immediately, after R1 was changed/treated, the facility staff contacted the Administrator and notified of an incident. Administrator instructed them, via telephone, to put an ice and ointment (aloe vera) on the wound. After the Administrator arrived to the facility and observed R1’s burn did not appear to be blistering and R1 did not complain of any pain, Administrator determined to wait for a Home Health agency that was already scheduled to come to the facility in the coming days. However, the Home Health agency did not come on their scheduled treatment date and even then, R1 was not taken to the hospital. Since R1 had also already been scheduled to see his/her primary doctor in the coming 5 days, the Administrator made a decision to wait, although by the 2nd or 3rd day, the burn began to blister. Even then, the Administrator did not call 9-1-1, instead the facility staff simply treated R1’s injury with over-the-counter ointment for 4 or 5 days. When R1 was ultimately taken to the hospital, R1's wound was classified as a 2nd or 3rd degree burn to 4% of R1's body. Based on the information gathered, there is sufficient evidence to conclude that the above allegations are Substantiated. A $500 immediate civil penalty is assessed today for a violation resulting R1's serious bodily injury. The Licensee/Administrator was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) or (f). Deficiencies/civil penalty were issued per CA code of Regulations Title 22 on LIC-9099D Exit interview conducted, appeal rights explained and a copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Feb 2, 2024 · control 31-AS-20230605162033

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(g) · Plan of correction due date: Feb 3, 2024

87465(g) Incidental Medical and Dental Care. The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health.... This requirement is not met as evidenced by: Based on the investigation, the licensee did not comply with the section cited above, as staff did not seek medical attention for R1 in a timely manner, which poses/posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 2, 2024

Plan of correction: The Administrator has agreed to do the following: Submit a Statement of Understanding, and the steps the facility will take to avoid similar issues from happening again and to ensure compliance to the cited regulation This is a zero tolarance and an immediate civil penalty of $500.00 will be assessed

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(d)(5) · Plan of correction due date: Feb 3, 2024

87411(d)(5) Personnel Requirements – General: (d) All personnel shall be given on the job training... This training and/or related experience shall provide knowledge of and skill in the following... (5) Knowledge necessary in order to recognize... the need for professional help. This requirement is not met as evidenced by: Based on the investigation, the licensee did not comply with the section cited above, as the facility staff walked away and left a hot soup on an unstable table and failed to provide an appropriate supervision. Although, the staff was trained with all the required basic services, the staff did not immediately call 911. Instead, they contacted the Administrator who made a decision to wait for R1’s doctors appointment that was already scheduled on a 05/30/23 (5 days after the incident), which poses/posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 2, 2024

Plan of correction: Licensee agreed that all personnel (current and or future) will receive the required training. A verification of staff training will be submitted to CCLD by POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87405(b) · Plan of correction due date: Feb 3, 2024

87405(b) Administrator - Qualifications and Duties: (b) The administrator of a facility or facilities shall have the responsibility and authority to carry out the policies of the licensee. This requirement is not met as evidenced by: Based on the investigation, the Administrator did not comply with the section cited above, failing to follow and carry out an emergency policy, which poses/posed an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 2, 2024

Plan of correction: Licensee agreed that the facility Administrator, designee and all staff will be trained on 911 situations and emergency step-by-step procedure for the residents. Proof of training will be submitted to CCLD by POC date.

Allegation investigated: Resident sustained pressure injuries while in care.

This is an Amendment to the original report issued 02/02/2024. Additional information was added to clarify the investigation. Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced subsequent visit to this facility to deliver the final report. LPA met with Amorlina Comedia, Staff #1 (S1), who granted access to the facility. S1 contacted the Administrator and LPA explained the reason for the visit. Administrator was unable to come to the facility and designated S1 to sign the report. On 01/10/2024, the Woodland Hills South Adult and Senior Care Regional Office received a complaint regarding the allegation, “Resident sustained pressure injuries while in care.” On 01/17/2024, LPA Panushkina initiated the complaint. LPA conducted tour of the facility and obtained copies of pertinent information which include but not limited to Physician’s Report (dated 08/24/2022), Admission Agreement (dated 09/18/2022), Appraisal Needs and Services (dated 05/01/2023) and Facility Policies and Procedures (Assessment and Retention). During the visit LPA was informed that R1 was receiving Physical Therapy. Continue on LIC9099-C Substantiated However, R1's file was not available and or missing and LPA was unable to confirm the name and contact information of the agency, frequency of the visits conducted, services provided, etc. LPA also conducted interviews with the Administrator, one (1) out of two (2) staff members and two (2) out of four (4) residents who were able to communicate. On 01/24/2024, LPA Panushkina Subpoenaed R1’s Medical Records. LPA received all requested Medical Records on 01/31/2024. Allegation: Resident sustained pressure injuries while in care The investigation findings revealed that Resident #1 (R1) had been living at this facility since September 18th, 2023. Interview with the Administrator revealed that R1 was in bed, most of the time, and the facility staff would reposition R1 every 2 hours. Administrator informed LPA that R1 didn’t like to lay on a side and would always turn to his/her back. Interview with the Administrator also revealed that he was not aware of R1 having any pressure injuries until R1 was taken to the hospital on 01/09/24. Moreover, interviews with two (2) staff members confirmed that R1 had been repositioned every two (2) hours while living at the facility. Both staff members also informed LPA that no pressure injuries were observed on R1’s body. In addition, interview with S2 revealed that he/she provided bed-bath to R1 every day and on 01/09/24, right before R1 was taken to the hospital, S2 noticed a redness around R1’s coccyx area. Review of R1’s Medical Records revealed that R1 was admitted to the hospital (1st time) on 12/22/23 and got discharged on 12/26/23. “Summary of Patient Progress” notes revealed that no skin injury was noted on R1 until 12/25/23 at 2:48pm. As for the type and location it was described as: blanchable redness on buttocks/sacrum/coccyx. Prior to re-admitting R1 back to the facility, facility staff failed to do a re-assessment for R1 prior to discharge on 12/26/23. Therefore, the Administrator failed to get R1 on Hospice, Home Health or obtain a Wound Specialist to address this issue. Subsequently, on 01/09/24, R1 was re-admitted to the hospital, and a review of hospital records revealed that R1 had multiple pressure injuries, from redness, various stage three (3) open injuries and one unstageable injury were discovered.Based on the information gathered, there is sufficient evidence to conclude that the above allegation is Substantiated. A $500 immediate civil penalty is assessed today for a violation resulting R1's serious bodily injury. The Licensee/Administrator was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(e) or (f). Deficiencies/civil penalty were issued per CA code of Regulations Title 22 on LIC-9099D Exit interview conducted, appeal rights explained, and a copy of this report signed and delivered.the state’s words, verbatim · CDSS document, Feb 2, 2024 · control 31-AS-20240110162135

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(1) · Plan of correction due date: Feb 3, 2024

Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed by each facility... (1) The licensee shall arrange... for medical and dental care appropriate to the conditions and needs of residents. This requirement is not met as evidenced by: Based on interview and record reviews, licensee did not comply with the section cited above by providing care to R1 without hiring a Wound Specialist and or a medical professional from 12/26/23 to 01/09/24, which poses/posed an immediate health and safety risk to resident in care.the state’s words, verbatim · CDSS document, Feb 2, 2024

Plan of correction: The Administrator has agreed to do the following: Submit a Statement of Understanding, and the steps the facility will take to avoid similar issues from happening again and to ensure compliance to the cited regulation This is a zero tolarance and an immediate civil penalty of $500.00 will be assessed

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(a) · Plan of correction due date: Feb 9, 2024

Reappraisals: (a) The pre-admission appraisal shall be updated, in writing as frequently as necessary to note significant changes and to keep the appraisal accurate. The reappraisals shall document changes in the resident's physical, medical... This requirement is not met as evidenced by: Based on interview and record reviews, licensee did not comply with the section cited above. Adminsitrator confirmed that upon R1's discharge from the hospital on 12/26/23, R1's reappraisal was not updated, which poses/posed a potential health and safety risk to resident in care.the state’s words, verbatim · CDSS document, Feb 2, 2024

Plan of correction: Administrator agreed to submit a statement of understanding on how all residents will have a proper reappraisal when changes occur and coming out of the hospital to ensure their needs are met. Proof of statement shall be submitted to LPA by POC date.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Angela Panushkina conducted unannounced visit to this facility in conjunction with a complaint control #31-AS-20240110162135. LPA met with the Administrator and explained the reason for the visit. During the visit, S1 informed LPA that S2 started working at this facility on 01/13/2024. LPA conducted review of Licensing Information System and did not observe S2's association to this facility. LPA informed the Administrator that all staff members must be fingerprint cleared and associated prior to employment. Moreover, S1 informed LPA that R1 was hospitalized in December 2023 (discharged on 12/26/23) and hospitalized again on 01/09/24. LPA reviewed all incident reports on a system and did not observe an Incident Report regarding R1. In addition, the Administrator admitted that no incident was 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. LPA informed the Administrator that all staff members are mandated reporters and they are all responsible for reporting. LPA informed the Administrator to submit the following two (2) incidents that occurred on: 12/21/23 01/09/24 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 and copy of report signed and delivered.the state’s words, verbatim · CDSS document, Jan 17, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Jan 18, 2024

87355 Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified... This requirement is not met as evidenced by: Based on record review, the licensee did not comply with the section cited above. S2's first day of work was on 01/13/24 and as on 01/17/24 S2 is not associated to the facility which poses an immediate health, safety risk to persons in care.the state’s words, verbatim · CDSS document, Jan 17, 2024

Plan of correction: Administrator has agreed to either have the staff get fingerprinted or submit the request for transfer. Administrator will provide an updated LIC500 to reflect new staff.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)A,B&D · Plan of correction due date: Jan 24, 2024

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: Based on interviews and record reviews, conducted by LPA, the licensee did not comply with the section cited above by failing to notify CCLD regarding the two (2) incidents that occured between December 2023 to January 2024, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Jan 17, 2024

Plan of correction: 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. Copies of two (2) incidents for R1, shall be submitted to LPA by POC date.