Correction check·November 9, 2022

At approximately 9:20 a.m. on 11/09/2022, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced Plan of Correction visit. LPA met with staff and disclosed the reason for the visit. On 09/28/2022 LPA investigated complaint #31-AS-20220923175322 and substantiated the allegation of resident records not maintained at the facility. A Proof of Correction due date was set for 10/28/2022. LPA called Administrator Armine Arkelian and Licensee Anna Gharibyan to remind them of the POC due date. LPA called Administrator Armine Arkelian on 11/08/2022 to remind that the Proof of Correction was not received in time. On 11/09/2022 at 9:35 a.m. LPA reviewed resident records at the facility as part of complaint investigation #31-AS-20221108101558. LPA observed the following deficiencies: Resident #1 (R1) had an Admission Agreement with missing signatures and no date, no LIC 602A Physician’s Report, an incomplete LIC 603 with no date, an incomplete LIC 621 with missing signatures and no date, and an incomplete LIC 625 Needs and Service Plan with missing signatures and no date. Resident #2 (R2) had an Admission Agreement with no signature and no date, an incomplete LIC 603, and an incomplete LIC 625 Needs and Service Plan. Resident #3 (R3) had no LIC 602A Physician’s Report, an incomplete LIC 603 with missing signatures and no date, and an incomplete LIC 625 Needs and Service Plan. Due to the failure to correct the deficiency cited on 09/29/2022, a civil penalty of $100 per day is hereby assessed for the period of 10/29/2022 – 11/09/2022 in the amount of $1,200 (12 days x $100/day). Daily civil penalties will continue to accrue until the deficiency is corrected. The civil penalty is issued on the attached LIC 421FC page. Exit interview conducted. Copy of report provided. Appeal rights discussed.