Incident investigation·July 3, 2023

LPA Albert Johnson made an unannounced health and safety check. LPA met with Staff. LPA checked the medications, menu, food/snacks and staff /resident files. Staff confirmed that 1 resident has moved out which brings the census to 5. The residents appear to be in good health at this time and there are no immediate safety concerns. The facility does not have an activity calendar (not required for a six bed facility 87219(d)) and the residents confirmed that there are no coordinated activities, however, the residents have the option to listen to music, walk in the back yard, explore the internet on their tablets or watch television. The residents on-going or annual appraisals are written on the "Pre- appraisal form" the facility is using the wrong form to document the reappraisals. The following forms need updating and submitted to CCLD by 07/10/2023: LIC 308- Designation of Administrative Responsibility LIC 500 - Personnel Report with the Administrator hours included Exit interview conducted advisory given.