Follow-up·April 6, 2022

Licensing Program Analyst (LPA) Jesse Gardner arrived unannounced to conduct a health and safety check of the facility. LPA was met with Caretaker Elizabeth Franco (S1), and they accompanied LPA on a tour of the facility. The health and safety check included an overall tour of the facility including all resident rooms, bathrooms, and a tour of the kitchen and food supply. The required food supply per Title 22 Division 6 Article 10 87555(b)(26) was not adequate; thus, a Technical Violation was issued. Licensee to provide proof of food delivery via email by today's date. Also, upon review of the LIC500, LPA found a caretaker (S2) not to be associated with the facility. S2 has a fingerprint clearance, but is not associated to the facility. LPA observed a completed transfer request form; however the information was not placed into Guardian. Licensee to complete the association through Guardian. LPA observed sufficient staffing while at the facility. There were no further health and safety concerns noted during the visit. At the conclusion of the visit, LPA observed no deficiencies during today's inspection. LPA noted that remaining items to be obtained are as follows: Lease Agreement Articles of Incorporation Death Certificate Documents from Secretary of State Licensee to deliver these items to the Department no later than 4/20/2022. An exit interview was conducted and a copy of this report was discussed with and provided to Ms. Franco.