Follow-up on corrections·March 2, 2022

On 03/02/2022, at 1:35 p.m., Licensing Program Analyst (LPA) Sandra Urena, conducted an unannounced Case Management-Deficiency visit to address the deficiencies noted during complaint control # 29-AS-20210813133851, conducted on 08/18/2021. LPA Urena spoke with administrator Siranush Alvadzhyan, and explained the reason for the visit. At 2:30 pm on 08/18/2021, the LPA conducted residents’ file review, and the LPA found that the facility failed to ensure that a resident’s file for Resident #1 (R1) was completed prior to the time of admission. LPA interviewed Staff # 1(S1), and S1 stated that Resident R1 arrived in the middle of the night, and didn’t have time to create a resident’s file. The R1 resided at the facility from 07/18/2021 to 07/21/2021. The licensee did not create a file for R1 with all the required documents prior to admission, and during R1’ s stay at the facility. The following documents were missing: · Resident Appraisal RCFE (LIC 603A) . · Appraisal Need and Services Plan, when applicable (LIC 625). · Physician’s Report for RCFE (LIC 602A) Residential Care for the Elderly, · Medical Assessment Section 87569 and General Requirements for Allowable Health Conditions, · (Section 87702.1). · Identification and Emergency Information (LIC 601). · Current admission agreement with authorized signatures, Admission Agreement Guide for RCFE · (LIC 604A). · Evidence of receipt of personal rights information by resident and/or authorized representative Personal Rights (LIC 613C). · Reports of safeguards for resident cash resources including supporting receipts of expenditures. · Record of Client’s/Resident’s Safeguarded Cash Resources (LIC 405) and record of each resident’s personal property and/or valuables entrusted to facility, Client/Resident Personal Property and Valuables (LIC 621). Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Deficiencies were issued today. Exit interview was conducted. Today's report was reviewed and signed by Siranush Alvadzhyan. Citations and and Appeal Rights were reviewed and provided. A copy of the report was issued via email.