Correction check·July 8, 2021

Licensing Program Analyst (LPA) Nicol Wesley conducted an unannounced Proof of Corrections(POC) visit and met with Office Manager Jerry Lo and discuss the purpose for todays visit which is to verify/confirm that one of the Type A deficiency during the case management visit conducted on 07/02/2021 have been corrected/cleared. On 07/02/2021 deficiency was cited as follows: 1). Type A, 87202(a)(2)-Fire Clearance. Fire Clearance All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department...Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department... This evidence has not been met as required by: The facility license was approved to retain 1 bedridden resident and currently LPAs observed there to be 2 bedridden residents(room 15 and room 10) residing in the facility. This poses a health and safety risk. **Immediate civil penalty will be assessed**. The Licensee/Administrator will immediately relocate one of the bedridden residents to the designated bedridden room(room 11) today. Plan of Correction. Licensee/Administrator is contact the fire department Fire Marshal provide information, submit LIC 200 and facility sketch(identify the location for bedridden residents) to the licensing department immediately and/or by the next business day. Office manager Jerry Lo advised that he contacted the fire department and received instructions on how to proceed. Continued on LIC 809C. On 06/26/21, LPA Wesley received signed Physicians report dated 06/25/21 from Office Manager Jerry Lo which indicated that both Resident 2(R2) and Resident 3(R3) ambulatory status is bedridden in which the facility was only granted allowance to retain 1 bedridden resident in designated room #11 per the LA County Fire Department Fire Safety Inspector. On 07/03/21, Office Manager Jerry Lo sent LPA Wesley an email advising that R2 was relocated to room #11 and R3 status is Non-Ambulatory. During todays visit, LPA Wesley observed that bedridden Resident(R2) was relocated from bedroom #15 to the approved designated bedridden room(#11) on 07/03/21, and was informed that Resident(R3) obtained an additional Physician's report dated 07/03/2021 which indicates that Resident 3(R3) is non ambulatory. Office Manager Jerry Lo advised that a copy of the LIC 200 and facility sketch was sent to CCLD on 07/07/21 via certified mail. LPA Wesley received copies of the current Physician's report for R3 and a copy of the documents that were mailed to CCLD to request additional bedridden capacity. This deficiency was cleared on 07/03/21 and there will be no additional civil penalties given for this deficiency. There were no additional deficiencies cited during todays visit. Exit interview conducted and a copy of the report was given to Office Manager Jerry Lo.