Correction check·August 19, 2022

On 8/19/2022, at 1:00PM, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct proof of correction (POC) visit. LPA met with Levi Villareal, Licensee, and explained the purpose of the visit. Facility has the following deficiencies that were not cleared : 87632(a), LPA have not received documents to request a hospice waiver from Licensee after annual inspection visit 8/11/2022. 87405(a), LPA have not received plan on what facility would do until they hire an Administrator or recertify as Administrator, after annual inspection visit 8/11/2022. LPA gave 30-days (9/19/2022) for Administrator new hire. 87506(a), LPA did not receive self-certification stating that R1's file was complete and on today's date R1's file is still not complete after annual inspection visit 8/11/2022. Civil Penalties for 87632(a) in the amount of $700 assessed immediately for the period of 8/13/2022 - 8/19/2022. Civil Penalties for 87405(a) in the amount of $100 assessed immediately for the period of 8/19/200 - 8/19/2022. Civil Penalties for 87506(a) in the amount of $100 assessed immediately for the period of 8/19-2022 - 8/19/2022. Continued on LIC809C. Continued from LIC809. Civil Penalties in the total amount of $900 is assessed today for failure to meet POC date for deficiencies. Facility is subject to ongoing civil penalties until deficiency is corrected. Exit interview conducted. A copy of this report, appeal rights provided and LIC421FC provided.