Correction check·June 30, 2021

Licensing Program Analyst (LPA) Lourdes Montoya conducted an unannounced case management visit for the Plan of Correction (POC). Upon arrival, LPA Montoya called the facility, spoke with the Licensee Bessie Coello and conducted a risk assessment. Based on the assessment, the facility is clear of Covid-19 infection. At around 10:40 am, LPA Montoya met with House Manager Cynthia Campos and they both toured the facility. LPA explained the purpose of today’s visit is to ensure that the deficiencies cited during the Annual Inspection on 6/9/2021 were corrected and in compliance with Title 22 Regulations. Licensee arrived later and joined the visit. On 6/9/2021, LPA Montoya observed below deficiencies and Title 22 regulations were cited, Proof of Corrections (POCs) were due on 6/21/2021. 1. Section 87307(d)(4) - Based on LPA's observation and photos taken, old chairs, mattress, a loose wooden fence and small pieces of wood are potential obstructions and hazards to residents. This poses a potential health, safety or personal rights risk to persons in care. POC due 6/14/2021. Licensee agreed to remove all the obstructions and hazardous items in the backyard and sideyard of the facility by the POC due date. Licensee will email photos of the cleared open areas of the backyard and sideyard. 2. Section 87465(e) - Based on LPA's observation, interview with the house manager and photos taken, residents' nonprescription PRN medications have physician's orders but there are no labels on the medications. This poses a potential health, safety or personal rights risk to persons in care. POC due 6/21/20. Report Continued in LIC 809C Licensee agreed to ensure all residents' nonprescription PRN medications are labeled by the POC due date. Licensee will email LPA photos of labeled nonprescription PRN medications. 3. Section 87303(d)(2) - Based on LPA's observation and photos taken, a closet accessible to residents is in disrepair. The closet floor and ceiling have large holes and the wall has small holes. This poses a potential health, safety or personal rights risk to persons in care. POC due 6/22/2021. Licensee agreed to repair the closet wall, floor and ceiling by the POC due date. Licensee shall immediately make the closet inaccessible to residents by installing a padlock. During today’s visit, LPA Montoya observed citations on Section 87303(d)(4) and Section 87303(d)(2) have been corrected. However, LPA observed citation on Section 87465(e) has not been corrected. The POC due date was 06/21/2021. A civil penalty of $900 is assessed at $100 per day, for the period of 06/22/2021 thru 06/30/2021 beginning on the day after the Plan of Correction was due. Based on LPA’s interview with Licensee and House Manager, all four cameras in the common areas and the ring doorbell with a camera are not charged and not currently working. This deficiency was cited under Title 22 regulations. Exit interview conducted. A copy of the report and POC letters were provided to License Bessie Coello.