Follow-up on corrections·April 29, 2021

Licensing Program Analyst (LPA) Noemi Galarza conducted a Case Management-Deficiencies visit as a result of observations made while conducting complaint investigation control #: 28-AS-20210405154549. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s meeting was conducted telephonically with Administrator/Licensee Theresa Kholoma. Staff (S2) assisted with today's virtual physical plant tele-inspection. Based on observations during two virtual physical plant inspections conducted while investigating an unrelated complaint on dates 4/14/21 at 11:02 am - 11:22 am & 1:30 pm - 1:45 pm, and today 4/29/21 at 9:27 am- 9:35 am two beds were observed in the attached garage. Both beds had linens, pillows, and a night stand dresser with staff personal belongings. Male staff clothing was observed hanging above the beds. On 4/14/21 during a complaint tele-inspection both Administrator and staff (S2) said the beds were placed in the garage because 2 residents required hospital beds. The regular room beds were moved to the garage for storage. However, caregiver staff (S2) was interviewed and confirmed "I sleep and take rests there." Staff (S2) stated the beds are also used by other caregivers as for nap time. Pictures were taken during the physical plant inspections. NOTE: pre-licensing report states room #5 is designated as a live-in staff room, but it is presently being used by a resident. Administrator and staff (S2) stated there is o nly one staff scheduled to work during the night shift that is responsible for night supervision. Per facility plan of operation "Dementia Care Plan of Operation" page 7, "At least one staff member will be awake and on duty at night, if required, based on wandering or other similar risks." Currently a total of three (3) residents in the home have a Dementia diagnosis. Per Title 22, Division 6, Chapter 8, Article 12, 87705(c)(4)(A) Care of Persons with Dementia. In addition to requirements specified in Section 87415, Night Supervision, a facility with fewer than 16 residents shall have at least one night staff person awake and on duty if any resident with dementia is determined through a pre-admission appraisal, reappraisal or observation to require awake night supervision. Based on observations deficiency is being cited. See LIC 809D. A telephonic exit interview was conducted with Administrator Theresa Kholoma. A hard copy of the report was emailed. Staff was instructed to sign the LIC 809/LIC 809D report pages and return to LPA.