Correction check·August 14, 2025

To follow up on deficiencies cited on 7/31/25--for which civil penalty of $100 accrued daily for one deficiency starting on 8/5/25--and 8/5/25, LPA Jeung reviewed corrections that were submitted to licensing office on 8/13/25. The following deficiencies are corrected, and acknowledgement of corrections is issued--5 pages: - Section 87204 Limitations - Capacity & Ambulatory Status Updated MD report for Client #1 states that client is Non-ambulatory Civil penalty of $700 is assessed today, which represents civil penalty of $100/day for period 8/6/25 through and including 8/12/25. See LIC421FC. - Section 87608 Postural Supports MD orders for half bed rails for clients #1, #3, #5, #6 were sent to CCLD - Section 87506 Resident Records Emergency information for clients #1, #2, #4 were sent to CCLD - Section 87411 Personnel Requirements Proof of current first-aid training for staff #2, #3, #4, #5, #6 sent to CCLD - 87465 Incidental Medical Care First-aid manual is observed at facility Continued on next page The following deficiencies cited on 7/31/25 still exist, as plan of corrections was not submitted to CCLD: - CCR 87457(c) Pre-Admission Appraisal Appraisal for client #5 will be completed, signed and dated BY CLIENT OR REPRESENTATIVE AND FACILITY REPRESENTATIVE - Health and Safety Code 1569.695(b) - Health and Safety Code 1569.695(c) - 87463(a) Reappraisals Appraisals for all clients will be completed, signed and dated BY CLIENT OR REPRESENTATIVE AND FACILITY REPRESENTATIVE - CCR 87611(b)(1-3) General Requirements for Allowable Health Conditions - CCR 87412(a)(1-13) Personnel Records The following deficiencies cited on 8/5/25 still exist, as plan of corrections was not submitted to CCLD: - CCR 87468.1(a)(1) Personal Rights "Explanation" was submitted, but affirmation that clients have the right to NOT be confined in bed was NOT submitted - Health and Safety Code 1569.69(a) - Health and Safety Code 1569.626(a) - Health and Safety Code 1569.696(a) - CCR 87411(f) Health screenings were not submitted for 6 staff - CCR87618(b)(1)(B) - CCR 87465(h)(1)(4) - CCR 87468.1(a)(13) - CCR 87465(i)(1-4) - CCR 87465(e)(1-4) Administrator Maria Johnson is advised that failure to correct the cited deficiencies on or before the Plan of Correction due date may result in a civil penalty assessment. As per phone conversation, additional time is needed to submit corrections. Written request shall be submitted to CCLD by close of business TODAY, with requested revised due date.