Correction check·July 14, 2021

On 7/14/2021 at 2:00 pm, Licensing Program Analyst (LPA) Lourdes Montoya and Licensing Program Manager (LPM) Angela Kendrick 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 2:09 pm, LPA Montoya and LPM Kendrick met with House Manager Cynthia Campos, and waited for the licensee. LPA explained the purpose of today’s visit is to ensure that the deficiencies cited during the Annual Inspection on 6/9/2021 and subsequent POC visit on 6/30/2021 were corrected and complied with Title 22 Regulations. Licensee arrived later and joined the visit. On 6/9/2021, LPA Montoya cited the facility for the following deficiency under Section 87465(e): LPA's observation, interview with the house manager, and photos taken indicate residents' Over the Counter (OTC) and PRN medications have physician's orders, but there are no labels on the medications. The POC was due on 6/21/2021. LPA Montoya conducted a POC visit on 6/30/2021 and found that the licensee failed to correct the deficiency. LPA observed the following OTC medications don’t have pharmacy labels: Continued in LIC 809C Resident #1 1. CVS D3 25 mcg 2. GoodSense Aspirin 81 mg 3. Kirkland Signature Calcium Citrate Magnesium and Zinc with Vitamin D3 Resident: #2 1. Signature Care Vitamin D3 50 mcg 2. Dr. Choice Antacid Tablets Calcium Carbonate 750 mg 3. Nature’s Bounty Fish Oil 1200 mg / 360 mg of Omega-3 4. Nature Made B12 1000 mcg 5. Major Acetaminophen tablets 325 mg 6. Signature Care Aspirin 81 mg Resident:#3 1. CVS Health Stool Softener Docusate Sodium 50 mg 2. Kirkland Signature D3 50 mcg 3. Tylenol Resident: #4 1. Tylenol 500 mg Resident: #5 1. Nature Made B12 1000 mcg Continued in LIC 809C During today’s visit, Licensee informed LPA Montoya and LPM Kendrick that she is working on her appeal and will be sending it within 15 business days from the citation date. LPM Kendrick reviewed the MAR and medications of R#1. LPA reviewed the facility's Plan of Operation and provided a copy of facility's medication policy to the licensee during today’s visit. Licensee informed LPM Kendrick that the use of surveillance cameras are included in the Plan of Operation since the issuance of the facility license. Exit interview conducted and a copy of this report was provided to the Administrator Bessie Coello.