Follow-up on corrections·June 29, 2021

Licensing Program Analyst(s) (LPA) Mary Flores conducted a case management visit due to deficiencies related to required reporting requirements that must be reported to Pasadena Department of Public Health (PDPH). On 6/17/21 LPA Flores was contacted by PDPH representative and notified LPA regarding facility not providing required documents upon admission of new residents to PDPH. On 4/22/21 Facility's administrator Virginia Garcia, assistant administrator Lori Lackey, Community Care Licensing Division (CCLD) Regional Manager Araceli Ramirez, Licensing Program Manager (LPM) Rebecca Orendain, LPA Flores, and PDPH Facility's assigned nurse Whitney Frame held an office meeting in which it was discuss facility will ensure to submit 2 out of 3 documents within 24 hours upon admission of new residents to the facility; ALW Verification of Approval, Vaccination Card, and/or Declination of Vaccination which could be submitted before admission, the day of, or 24 hours after admission. On 6/29/21 LPA Flores reviewed email from PDPH nurse and facility has failed to submit one or more documents within 24 hours of admission for resident #1(R1), #2(R2), #3(R3), #4(R4), #5(R5), #6(R6), #7(R7) as required by PDPH under COVID 19 recommendations and guidelines. Per Title 22, Division 6, Chapter 8, Section 87211 Reporting Requirements;21 facility is to report to the department in this case PDPH of any occurrences within 24 hours. Therefore, deficiencies will be cited in the attached LIC 809D. Exit interview was conducted Lori Lackey Assistant administrator with and a copy of this report was provided.