Health check·September 14, 2023

On 9/14/23 at approximately 1:40 pm Licensing Program Analyst Jennifer Fain and Licensing Program Manager Liza King arrived at the facility to conduct a follow up Legal Noncomplaince Case Management Visit from 8/25/23. LPA and LPM met with Stephanie Siewe and explained the reason for the visit. On 8/30/23 LPA Fain received requested documents: 602s for all residents and the facility sketch. During the Informal Meeting on 4/12/23 the licensee agreed to “evaluate the current STD850 to ensure that they are in compliance with the state Fire Marshall; The facility has a non-ambulatory fire clearance for each room that will be used to accommodate a resident with dementia within 2 days; submit an updated LIC200 and facility sketch.” Based on the 602’s supplied for the residents, the facility sketch, and rooms the residents are staying in (provided by S1 on 8/25/23), there are 8 non-ambulatory residents , 4 of them are in ambulatory rooms. Also, during the Informal meeting, the Licensee agreed to “Conduct a self-assessment of all resident and personnel files within 30 days and make needed updates per requirements.” Based on the 602’s received 4 of 6 are past the due date for the required one year health evaluation. LPA requested Discharge papers for R1 from hospital visit on 8/5/23 and related SIR. LPA requested Incident Reports and discharge papers for R2 for the months of June, July and August 2023. A civil penalty of $500 is being issued during today's visit for violation of California Code of Regulations Title 22 Section 87204(b). The facility is not in compliance with Title 22 Regulations, the deficiencies can be found on the LIC 809-D page. An exit interview was conducted with Stephanie Siewe, and a copy of this report and appeal rights were provided to Stephanie Siewe.