Follow-up on corrections·February 3, 2023

At approximately 9:00AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Case Management - Deficiencies Visit and met with the front desk receptionist. Resident Relations Director, Arlene Samonte (AS), arrived later during visit at approximately 9:15AM. Executive Director/Administrator, Ricardo Romero, arrived later during visit at approximately 10:00AM. The purpose of the visit was to follow up on self-reported incidents that were submitted to Community Care Licensing (CCL). LPA conducted a walkthrough with Resident Relations Director and Executive Director/Administrator. LPA and Executive Director discussed the following: Covid and Influenza A Protocols Staffing Incident Reports LPA reviewed the following reports with Executive Director: Incident Report 1: CCL received an incident report on 10/4/2022. Report states that on 9/26/2022, Resident 1 (R1) was found on the floor. Resident was observed to be unable to verbalize the event and only say their name. Facility called Emergency Personnel to evaluate and R1 was sent to the hospital. Facility made all appropriate notifications per regulation. LPA and Executive Director discussed R1. As of 2/3/2023, R1 has since moved out of the facility due to changing care needs. Continued on LIC 809-C Continued from LIC 809 Incident Report 2: CCL received an incident report on 12/30/2022. Incident report states that on 12/19/2022, Resident 2 (R2) was taken to the hospital by family after attending an appointment. Facility made all appropriate notifications per regulation. LPA and Executive Director discussed R2. As of 2/3/2023, Facility has been monitoring R2 appropriately. Incident Report 3: CCL received an incident report on 12/6/2022. The report states that on 11/30/2022, Resident 3 (R3) was given an incorrect amount of medication. Facility contacted R3's Physician and followed Physician guidance provided. Facility made all appropriate notifications per regulation. LPA and Executive Director discussed R3. Facility submitted In-Service Training for all staff who handle medications on 12/6/2022. Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. *Facility submitted Medication Training and training documents to CCL on 12/6/2022. Deficiency cited on 2/3/2023 has been cleared during this visit.* Exit interview conducted. Copy of report, LIC-809D, LIC9102 (Technical Violation), LIC 811 (Confidential Names), Plan of Corrections, Appeal Rights, and Plan of Corrections Letter, discussed and provided to Administrator. Signature on form confirms receipt of documents.