Routine inspection (multi-day)·June 5, 2024

Licensing Program Analyst (LPA) Shannan Hansen arrived at 10:00 AM to complete an unannounced continuation of annual inspection and met with Paul Freisen, Executive Director. There is a total of 214 residents. LPA initiated a file review of 5 staff records and reviewed centrally stored medication records to complete this annual inspection. During staff file review at approximately 10:30 AM it was revealed facility had not requested a clearance transfer for staff (S1) who had worked at facility since 1/9/2024, LPA contacted CCL RO that confirmed (see LIC 809-D & LIC421 BG for ICP). Staff (S1 & S2) did not have required current First Aid training/certificate (see LIC809-D). **Civil Penalty assessed in the amount of $500.00. LPA Hansen is requesting facility to update and submit the following documents by 6/30/2024 to CCL: LIC 308 Designation of Facility Responsibility LIC 500 Personnel Record LIC 610 Emergency Disaster Plan (if changes) LIC 9020 Register of Facility Resident’s Copy of Administrator Certificate Proof of Liability Insurance Continue on LIC809-C Appeal of Rights Given. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided..