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25 | Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management Visit to cite deficiencies identified during a separate complaint investigation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Christopher Diaz. LPA also spoke via phone with Licensee Dr. Mohammed Rahman, during the visit.
During records review, LPA observed: Licensee did not maintain in Resident #1 (R1)’s care records the name and contact information for R1’s current primary care physician (PCP), dentist, and nurse practitioner (NP), as required. The physician that was listed on R1's Face Sheet was obsolete. Interviews showed that the NP had come to the facility in person on prior occasions to provide care to R1 and had identified themselves to and interacted with facility staff. Licensee also did not maintain in Resident #2’s (R2) care records the name and contact information for R2’s current dentist, as required. [See LIC811 Confidential Names List for a description of R1 and R2]. Licensee also did not have file an LIC625 Appraisal/Needs and Services Plan (or equivalent “written record of care the resident will receive”) for R1 or R2. There was also no evidence that Licensee held a care-conference meeting with R1 and R2's responsible persons within the last twelve (12) months, as was required. Although R2’s responsible person could not be reached for interview, interview of R1’s responsible person confirmed they had not participated in a care conference with Licensee within the last year.
Two (2) deficiencies were cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D page). Plans of Correction were jointly developed with the Licensee.
An exit interview was conducted with Dr. Rahman, to whom a copy of this report, the LIC 809-D page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided. |
Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type B
11/11/2024
Section Cited
CCR
87506(b)(9)
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7 | 87506 Resident Records: “(b) Each resident’s record shall contain at least the following information: (9) Name, address, and telephone number of physician and dentist.” This requirement was not met, as evidenced by: | 1
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7 | During today’s site visit, LPA provided Licensee with the names and phone numbers for R1’s PCP and RP. Licensee agreed to update the Face Sheet for R1 to include the name, address, and telephone number for R1’s current PCP, NP, and dentist. Licensee agreed to update the Face Sheet for R2 to include the name, address, and telephone number for R2’s current dentist. Licensee agreed to E-mail the updated Face Sheets for R1 and R2 to LPA, by the POC due date. |
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14 | Based on records and interviews, for 2 of 2 residents (R1 and R2), Licensee did not ensure that their record of care contained the name, address, and telephone number for both their respective current dentist and physician. This posed a potential health risk to persons in care. | 8
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Type B
11/11/2024
Section Cited
CCR87467(a)
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7 | 87467 Resident Participation in Decisionmaking: “(a) Prior to, or within two weeks of the resident’s admission, the licensee shall arrange a meeting with the resident, the resident’s representative, if any, appropriate facility staff, and a representative of the resident’s home health agency, if any, and any other appropriate parties, to prepare a written record of care the resident will receive in the facility, and the resident’s preferences regarding the services provided at the facility.” | 1
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7 | Licensee agreed to complete an LIC625 Appraisal/Needs and Services Plan form on both R1 and R2, and to have both signed by their respective responsible person and a facility representative after a joint-review during a care-conference meeting. Licensee agreed to E-mail the completed and signed LIC625s for R1 and R2 to LPA, by the POC due date. Going forward, Licensee agreed to update the LIC625 and hold a care conference, for all residents, whenever there is a significant change in their condition, but also at least once every twelve (12) months, whichever occurs first. |
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14 | This requirement was not met, as evidenced by: Based on records reviewed and manager interview, Licensee did not have on file for 2 of 2 residents (R1 and R2) a completed LIC625 Appraisal/Needs and Services Plan (or equivalent “written record of care the resident will receive”), and the resident’s preferences regarding the services provided at the facility. This posed a potential health and personal rights risks to persons in care. | 8
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