Follow-up·February 18, 2022

Regional Manager (RM) Reyna Lacey, Licensing Program Manager (LPM) Deborah Mullen, and Licensing Program Analyst (LPA) Jesse Gardner conducted an unannounced visit to check for any immediate health and safety needs. Licensing staff met with Administrator Joi Ma Gubalane. Licensing staff toured the facility with Ms. Gubalane. Currently there are 2 caregivers to provide for the needs of the residents in care. Licensing staff reviewed and obtained copies of resident files. Ms. Gubalane will submit a packet to change administrator of record to herself. The packet will be submitted by the close of business on 02/22/2022. Ms. Gubalane will submit an updated Designation of Facility Responsibility (LIC308) by close of business on 02/22/2022. At approximately 08:50am, It was found that the facility did not have a fire clearance for bedridden residents. Licensee did not obtain a fire clearance for Resident Two (R2). Staff interviews revealed R2 needs assistance in turning and repositioning. A Type A citation was issued per Title 22 Division 6 Chapter 8 Article 12 and an Immediate civil penalty was issued in the amount of $500 for the absence of fire clearance for bedridden residents. At approximately 08:50am, a review of R2's file was conducted and revealed written instructions to caregivers that R2 is to be repositioned every 2 hours. Licensing staff observed S1, at approximately 12:55pm, request R2 to reposition on their own, and R2 indicated that they couldn't. An exit interview was conducted with Ms. Gubalane, and copies of this report along with LIC811, LIC809-D, and LIC421IM, and Appeal Rights were provided to Ms. Gubalane.