Non-compliance follow-up·November 12, 2024

On 11/12/2024 at 1:26PM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to conduct a Case Management Legal/ Non-compliance visit. LPA met with care staff, Francis Bucas. Francis contacted Administrator via telephone, LPA was informed by Kavitha Administrator, of being at work and gave authorization to Francis Bucas, care staff to sign reports. LPA observed that care staff was sitting with two residents watching television when LPA entered the facility. LPA did a walk through the facility including bathrooms, kitchen, living room, and outdoor area. LPA observed two (2) residents sitting in the common area watching television and two (2) residents in their bedroom in the bed with television on. LPA requested staff files for review, care staff stated she didn’t have the key and contacted Kavitha Pramod via telephone. Kavitha explained that the key is with her and that she will leave the key tomorrow with staff. LPA explained to Administrator, the importance of files being readily accessible to Licensing for review during all visits. Continue on LIC809C Continue from LIC809 LPA couldn’t review and confirm if the facility conducted two (2) hours of staff training on each of the topics below: 1. Observation of resident(s) on recognizing signs and symptoms of residents change of condition 2. When to call 9-1-1 after resident/s unusual incident and properly responding to residents' emergencies. 3. Training on reporting requirement to timely inform appropriate parties such as but not limited to; CCLD, residents’ responsible parties, Ombudsman, etc. 4. Training for recognizing non-verbal cues of pain for residents in care. At 2:00PM LPA observed staff and residents’ files were inaccessible for review due to being locked in a cabinet during visit. The deficiency was observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiency may result in civil penalties. Exit interview conducted with Francis Bucas. A copy of this report and appeal rights provided.