Follow-up·September 13, 2023

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management Visit – Other visit to review records. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Administrator Jared Green and Wellness Coordinator Jenna Purnell. During today’s visit, LPA briefly toured the facility and interviewed the administrator and other staff. LPA also reviewed disaster drill records, posted sketches showing evacuation routes, and the LIC602 Physician’s Reports for the residents who reside in the facility’s memory care areas. During record review, LPA observed: Licensee did not possess an LIC602 Physician’s Report or equivalent Medical Assessment for Resident #1 (R1). [See LIC 811 Confidential Names List for a description of R1.] One (1) deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC809-D). A Plan of Correction was jointly developed with the licensee. LPA also provided Technical Assistance (TA) regarding reporting requirements and requirements related to use of secured perimeter doors (refer to the attached LIC9201-TA pages). An exit interview was conducted with Green and Purnell, to whom a copy of this report, the LIC809-D, the LIC9102-TA pages, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.