Reference check·August 25, 2021

**Due to technical difficulties Licensing Program Analyst (LPA) generated report after visit, a handwritten copy with signatures was provided to administrator Adela "Claudia" Artan at time of inspection. Electronic copy of this report will be sent to administrator and LPA requests a signed copy is returned to Community Care Licensing (CCL) for facility records.** LPA arrived at the facility unannounced on 08/25/2021 to conduct a collateral visit, LPA met with administrator and explained the purpose of today's visit. Prior to conducting visit LPA completed required COVID-19 testing protocols and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms, LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask; administrator screened LPA upon entry. LPA conducted interviews with administrator and resident (R1) regarding a complaint filed against another facility, LPA requested administrator send LPA the following documents by 08/27/2021 to assist with complaint investigation: Proof of control of property;deed Copy of facility's liability insurance. R1's 602 and admission agreement. No deficiencies are cited as a result of today's inspection. Exit interview was conducted and a copy of this report was emailed to administrator. LPA requests a signed copy is returned to CCL by either fax or email.