Follow-up·November 29, 2021

At approximately 10:20am Licensing Program Analysts (LPAs) Shira Stamps and Angela Panushkina made an unannounced case management visit regarding an eviction notice. LPAs were greeted by staff, Steven Hang and Stone Acevedo. LPAs were asked to sign in, to answer COVID symptom questions, and temperatures were taken. LPAs met with Lourdes Kazdan(LK), the resident care director; and Mary Jane Reyes (MR), the wellness director, at approximately 10:32am., and explained the purpose of the visit. LPAs requested LIC 500, Resident roster, and documentation of the incident reports for the resident in question. LPA team interviewed LK and MR around 10:35am regarding the eviction notice. LK stated they have kept documentation of all incidents that occurred for the resident in question. LPAs reviewed Richard Scharfenstein's (R1) one (1) incident report and documentation of other incidents at approximately 2:00pm. LPAs reviewed previously submitted incident report history ,and did not find any reports that were provided/faxed to Community Care Licensing Department (CCLD). At 2:00pm, LPA team was given a copy of the eviction notice that was provided to R1 by the Administrator dated 11/10/21. Upon review, it was observed to be non-compliant under Title 22 regulation because it lacked the following information: (A) Failure to submit incident reports/documentation to CCLD to support the eviction notice. (B) Eviction notice was delivered to R1 before it was approved by CCLD. Based on the interview conducted with LK and MR,and the relevant documentation obtained, the eviction is not approved. Report reviewed, signed, and delivered. Exit interview conducted, appeal rights issued and deficiencies on 809-D page.