Follow-up on corrections·June 1, 2022

Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to issue an additional deficiency discovered during a recent complaint investigation. LPA met with Marlene Duncan, caregiver, who contacted the Administrator, Lani, by phone. LPA spoke to Administrator and explained purpose of inspection. LPA also observed caregiver, Fredricka Quarrie to be present. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols and completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. Additionally, LPA was screened per Covid-19 precautionary measures upon entering the community. LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: KN95 mask. LPA observed (5) residents to be napping/awake in their rooms at the start of the inspection. (1) resident was sent to the ER this morning and will be returning today. During the investigation of complaint 25-AS-20220128094750, it was discovered that resident records were not maintained for resident (R1) following resident's stay at the facility from 1/22/22 - 1/24/22. Administrator indicated that resident's responsible person requested that resident's records be shredded and disposed of due to containing personal information. LPA discussed with Administrator today the requirement to maintain resident records of reach resident for a minimum of (3) years, even if a resident or their representative requests they be shredded. LPA and Administrator discussed possibly redacting personal information such a social security number on the copies maintained at the facility. The additional deficiencies issued on 5/26/2022 were cleared during today's inspection as documentation of training was received by the Department on 5/27/22. Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following (1) deficiency is being cited on the 809D page. Exit interview. Copy of report and appeal rights to be e-mailed to the Administrator following today's inspection.