Incident investigation·September 9, 2022

Licensing Program Analyst (LPA) Jeremiah Randle arrived unannounced to conduct a Case Management – on 9/9/2022 at 10:25 PM. Upon arrival LPA were greeted at the door by Administrator. Resident census is 88 per administrator. LPA toured facility with Administrator Myla Belson including but not limited to bedrooms of the residents, as well as common areas of the facility. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained throughout the facility. LPA observed the facility to be operational and in good repair. Residents were currently engaged in activities and dining, LPA interviewed Administrator and two Residents. LPA requested pertinent documents pertaining to the investigation. The following documents were requested: Resident Roster, Staff Roster, Admissions Agreement, Needs and Services Assessment, physicians report, any other pertinent documentation of the residents in question. LPA Advised to Administrator to email documents requested to Jeremiah.Randle@dss.ca.gov. Further investigation needed and analysis of documentation. No citations were issued during this visit. An exit interview was conducted and a copy of this report was provided