Routine inspection (multi-day)·August 21, 2023

At approximately 9:30AM, Licensing Program Analysts (LPAs) Felias and Rummonds arrived unannounced to conduct a Required 1 Year Visit and met with Executive Director, Jessica Graham. Interim Executive Director, Morgan Ware, arrived approximately at 10:45. Facility is a Residential Care Facility for the Elderly that provides care and assistance for Older Adults in Assisted Living and Memory Care. Facility has an approved fire clearance for 81 Non-Ambulatory Residents, and 14 Bedridden Residents for a total capacity of 95 Residents. Facility has a Hospice Waiver for 10 individuals. Upon arrival, LPAs were informed that there were 39 Residents in care. LPAs were also informed there were 14 staff members on site. LPAs reviewed a sample size of 6 staff files. Review of files indicated that 4 of 6 staff files did not have proof of a negative TB test. 3 of 6 staff files reviewed did not have proof of a heath screening done. 3 of 6 staff files reviewed did not have proof of current First Aid/CPR certificates. 1 of 6 staff files reviewed also showed that Staff Member 1 (S1) was not fingerprint cleared or associated to the facility per regulation (This Deficiency has been cited, see LIC809D, Regulation 87355(e)) . LPAs contacted the Regional Office and confirmed the fingerprint clearance and association status of S1. Regional Office confirmed their fingerprint and association status to the facility. S1 was informed of their status and immediately left the premises. LPAs were provided documentation regarding the 6 staff files reviewed earlier. Documentation provided showed that Facility has some paperwork on-site regarding staff health screenings, TB tests, and first aid certification. Facility was able to provide documentation for the following areas identified above: 2 staff members missing their TB tests, and 3 staff members missing their health screening reports. LPAs were also provided with staff members who have current first aid/CPR certifications. Deficiencies have been cited for documentation unable to be provided during the time of visit for 2 of 6 staff files reviewed. These staff files are still missing proof of a negative TB test (This Deficiency has been cited, see LIC809D, Regulation 87411(f)). LPAs unable to complete the Annual Inspection. Annual Continuation Visit to be conducted at a later date. Continued on LIC809C Continued from LIC809 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. **A Civil Penalty in the amount of $1,000.00 is being issued today, due to a repeat violation of the same regulation regarding background clearance within a 12 month period. (See LIC421IM).** Exit interview conducted. Copy of report, LIC809D, LIC421IM, LIC811 (Confidential Names), Plan of Corrections, and Appeal Rights discussed and provided to Interim Executive Director. Signature on form confirms receipt of documents.