Follow-up·July 27, 2021

Licensing Program Analysts (LPAs) Luis Mora and David Sicairos conducted an unannounced case management visit to follow up on the case management visit conducted on 07/01/21. LPA Mora met with Kelvin Mate (applicant) and explained the reason of the visit. LPA Mora conducted a tour of the facility and observed the previous concerns: Beds in bedrooms #1, #2, #3, #4 were observed and were missing bedding items for each resident. ( LPA observed all beds have the required bedding ) Bed must be removed from the backyard, and ensure backyard is clean from cat feces. ( LPA toured backyard and observed a clean backyard ). Applicant will ensure all residents have all the required assessments and documents in resident files. LPA observed resident #1 and #2 were missing required documents in their files. Facility must obtain doctor's request for bed rails for R1. ( LPA reviewed resident documents and observed all required documentation and doctor's order for R1 bed rails was provided ). Applicant will submit a new LIC 200 and approved fire clearance indicating facility is able to serve 6 non-ambulatory resident, of which 1 may be bedridden. ( Residents were revaluated and none of them were deemed bedridden. Therefore, applicant will keep the original fire clearance which was approved for 6 non-ambulatory and 0 bedridden. Applicant will re-sign the original LIC 200 dated 04/16/21 with today's date 07/27/21. Since applicant is keeping the original approved fire clearance a new fire inspection is not necessary). (CONTINUED TO LIC 809C) No outstanding or pending items were observed by LPA requiring additional visits. LPA Mora will notify the assigned Centralized Applications Bureau (CAB) Analyst of the completed visit conducted. Exit interview conducted with Kelvin Mate applicant and a copy of this report was provided.