complaint·February 17, 2023

A subsequent unannounced complaint visit was conducted by LPA Christine Yee on 12/16/22 from 11:05am - 12:00pm to conduct further investigation of the above allegations. LPA Yee met Justin Levi, Licensee and the reason for the visit was explained. During the subsequent visit, LPA Yee obtained copies of vaccination cards for Resident #3 and #4 and conducted interview with Justin Levi, Licensee. Resident #1 was not available to be interviewed. Resident #2 through Resident #5 could not be interviewed due to dementia. The visit was terminated as needs further investigation due to insufficient information. On 1/5/23, LPA Ye e was able to reac h Resident # 1 via tele phone at 11:02am to conduct an interview regarding the above allegations. On today's visit LPA Yee conducted an other interview with Justin Levi, Licensee at 09:25am to clarify information collected on the prior visits to the facility regarding Allegation #1 - Staff did not ensure residents received COVID-19 vaccine. Per information obtained during the investigation, all facility residents had received both doses of the vaccine and the first booster shot when this complaint was received on 5/18/22. Resident #1 then requested the second booster, per Licensee in May 2022. However, there was some confusion as to the waiting period between boosters and if the other residents wanted the second booster since the pharmacy would not come to the facility for one resident. As the scheduling of the second booster shot was in the process of bein g addressed, the facility was impacted by Covid-19 . Three residents, including Resident #1, received positive Covid-19 test results on May , 16 2022 and would not be eligible for the second booster for ninety days. This further delayed the eligibility to receive the second dose of the booster vaccine and not due to the facility's failure to ensure that Continued on LIC9099-C the residents received the second booster. Once Resident#1 became eligible, the second booster was administered on 8/18/22. In regards to Allegation #2 - Staff are not wearing masks: per interviews conducted with the Licensee and Angelie Deleon, Resident Operations, the staff are required to wear a mask while working inside the facility and assisting the residents. The choice of mask to be used would be determined by whether there are any positive cases at the home. Surgical masks are worn inside the facility, if there are no positive Covid-19 cases and N-95s are required if there are positive cases. The facility provides staff with Personal Protection Equipment(PPE). The complaint states the staff wear surgical mask but should be wearing N95 daily. The staff are not required to wear N95 masks at all times as alleged in the complaint. The facility's masking protocol is in line with the guidance provided in Provider Information Notice(PIN) #21-38-ASC dated August 19, 2021. Per tour of the facility conducted from 10:49am - 10:56am today, the 2 caregivers present on today's visit, were observed wearing surgical masks. Based on the information obtained from the investigation, it is determined that the above allegations are UNSUBSTANTIATED. Exit interview was conducted with Angelie Deleon and a copy of this report was provided.