Correction check·November 13, 2023

Licensing Program Analyst (LPA) Pang Lee arrived at the facility on 11/13/2023 at 11:05 AM to conduct an unannounced Plan of Correction (POC) visit. LPA Lee was greeted by care staff, Cleopatra Gardiner and explained the purpose of today visit. The current Census is 6 with 2 staff present in the facility. The purpose of this visit is to follow-up on a plan of correction that was due 10/31/2023 and 11/09/2023. Care staff, Kaydia Sharp sent pictures and statement of acknowledgement of POC on 11/08/2023. LPA Lee toured and inspected the facility to ensure the deficiency previously cited on 10/26/2023 have been corrected. Licensee agreed to keep the facility floor plan as licensed. LPA Lee observed care staff moved back to room #10 and room #4 is for resident to reside in. LPA reviewed staff criminal record clearances and a review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility. Based upon this inspection, LPA Lee observed the following: 1. Deficiency cited under Title 22 Regulation 87465(a)(4) has not been cleared. The license did not complied with the terms of the POC by POC due date 10/31/2023. A POC letter was not generated and provided to the licensee. 2. Deficiency cited under Title 22 Regulation 87211(a)(1) been cleared. The license complied with the terms of the POC by POC due date. 3. Deficiency cited under Title 22 Regulation 87506(a) been cleared. The license complied with the terms of the POC by POC due date. 4. Deficiency cited under Title 22 Regulation 87309(a) been cleared. The license complied with the terms of the POC by POC due date. 5. 4. .Deficiency cited under Title 22 Regulation 87208(a)(7)(A) been cleared. The license complied with the terms of the POC by POC due date. Continued LIC 809-C The administrator did not complied with the terms of the POC by POC due date 10/31/2023. Exit interview conducted and a copy of this report provided. As a result of this annual visit, the facility is not in compliance with Title 22 Regulation, and the deficiencies can be found on the LIC 809 D page. An exit interview was conducted, and a copy of these LIC 809 reports, LIC 809-D page, and Appeals rights were provided to the facility.