Follow-up on corrections·September 26, 2023

Licensing Program Analyst (LPA) Vincent Moleski arrived unannounced to conduct a case management visit. LPA Moleski met with facility administrator Salote Lewis and explained the purpose of the visit. During a visit on 9/21/23, LPA Moleski reviewed residents' medication administration records (MARs). LPA Moleski observed the initials "IN" signing off on medication administrations on September 15 through September 17, 2023. During a visit on 9/21/23, LPA Moleski interviewed a staff member (S1) about who the initials belonged to. S1 said they belonged to an individual (S2) who filled in for S1 while S1 was out. S1 said he worked with S2 for one day, and S2 worked on their own afterward. During a visit on 9/21/23, LPA Moleski interviewed a resident (R1) who said an individual (S2) worked as a caregiver for a total of three days at this facility. During a visit on 9/21/23, LPA Moleski reviewed the Licensing Information System (LIS). The only individuals associated to this facility as of 9/21/23 were facility administrator Salote Lewis and S1. During an interview on 9/26/23, Lewis said this individual (S2) works on the weekends. Lewis provided this individual's full legal name. Lewis said S2 has a criminal record clearance. During an interview, on 9/21/23, S1 said that R2 suffered a fall on or around August 21, 2023, and was hospitalized until September 1, 2023. During interviews on 9/21/23, R1 and R2 both said that R2 had suffered a fall. LPA Moleski did not receive an incident report regarding R2's fall or hospitalization. [continued on 809-C] LPA Moleski reviewed discharge notes from R2's hospital visit dated 8/21/23 to 9/1/23. This facility is being cited per 22 CCR Sections 87355(e)(2) and 87211(a)(1)(D). An immediate civil penalty of $100 a day for three days, for a total of $300, is being assessed for a criminal record clearance deficiency. An exit interview was held and a copy of this report was left with Lewis.