Follow-up on corrections·May 16, 2023

Licensing Program Analyst (LPA) Emily Peraldi initiated a Case Management – Deficiencies visit to address deficiencies observed during a complaint investigation conducted on 05/16/2023 at the above location. At 9:28 a.m., the LPA met with staff and explained the reason for the visit. At 10:33 a.m., the Licensee arrived at the facility. Between 10:00 a.m. and 10:08 a.m., the LPA along with staff conducted a brief physical plant tour. Between 10:01 a.m. and 10:06 a.m., the LPA also interviewed four (4) out of six (6) residents. Between 10:09 a.m. and 10:30 a.m., the LPA conducted an interview with two (2) staff. At 10:34 a.m., the LPA conducted an interview with the Licensee. At 10:45 a.m., the LPA reviewed records and obtained copies of pertinent documents. Prior to visit, the LPA printed out the facility personnel report summary from the Licensing Information System (LIS). Upon arrival, it was revealed Staff #1 (S1) was recently hired. Per record review, conducted by the LPA on the Guardian website, S1 does have fingerprint clearance but is not associated to this facility. Interviews with the Licensee and staff revealed that S1 started working at this facility on 05/15/2023 . The Licensee stated that he will ensure that all staff will have a criminal record clearance and are associated to the facility prior to working at the facility. At 10:45 a.m., the LPA reviewed Resident #1’s (R1’s) records. R1’s death report was not completed or sent to Community Care Licensing Division (CCLD) within the required time frame. The Licensee explained that the facility was waiting for R1’s death certificate to send the death certificate along with the death report to CCLD. R1 passed away in January 2023 and the Licensee explained that him and his staff were very busy at the time. The Licensee agreed to complete and send a death report to CCLD for R1. Pursuant to Title 22 of the California Code of Regulations Division 6, Chapter 8, the following deficiencies were cited (refer to LIC 809-D). Civil Penalties assessed in the amount of $200. Failure to correct the deficiencies may result in additional civil penalties. Exit interview conducted, A copy of today's reports and appeal rights were provided. Civil penalties issued.