Non-compliance follow-up·May 30, 2025

Licensing Program Analyst (LPA) Christine Kabariti arrived unannounced to conduct the facility case management - legal/non-compliance visit (NCC). LPA met with Administrator, Bernellet Taa. The purpose of the visit is to ensure the facility is adhering to the compliance plan submitted to Community Care Licensing (CCL) after a non-compliance meeting held on 07/26/2024. During visit, LPA toured the facility with staff (S1) to include the living room, kitchen, dining room, 3 resident bedrooms, resident bathroom, staff bedroom, staff bathroom, Administrator's office, garage, and backyard. No cameras observed inside of the facility. LPA did not observe any concerns regarding the cleanliness of the facility. There was only 1 caregiver/staff (S1) working in the facility upon arrival. LPA observed a total of 3 live-in individuals who are all fingerprint cleared and associated to the facility roster. 1 out of the 3 individuals (S1) is a staff/caregiver of the facility. The 2 live-in individuals are family members of S1 and does not assist with any caregiver duties. S1 states the 2 individuals just help to clean the facility. Based on the facility's LIC500, the facility only has 2 main caregivers who work 7 days a week. S1 and S2 covers each other during break times to ensure the residents have staff supervision at all time. Based on the schedule and Administrator, there are certain times of the day where S1 and S2 are both present. Administrator is working on training another staff (S4) before starting work at the facility. A copy of the LIC500 obtained. SEE LIC809-C. The exit door leading to the backyard and entrance door observed with a door alarm. Staff demonstrated how to operate the door alarms, in which LPA observed the alarms were operable. On 01/27/2025, the Department issued the facility a deficiency due to the Licensee altering the facility's building and grounds without proper notification to the Department and building permits. The Administrator corrected the deficiency and submitted their plan of correction to the Department. During today's visit, LPA observed the all partition walls were removed and the facility's physical plant matches the facility sketch approved by the Department. LPA reviewed 4 out of 4 resident files. 4 out of 4 resident files contained a signed and updated appraisal/needs and services plan from 02/03/2025, admission agreement, medical assessment, TB result, and signed personal rights form. The resident's appraisal/needs and services plan includes detailed information regarding the resident's care needs & what the facility is doing to meet their needs, LPA reviewed 4 staff files. The 2 main staff members (S1 and S2) obtains an active 1st aid certification and updated training on topics to include (but not limited to) medication training, Alzheimer/dementia care, nutrition, and caregiver staff training. 4 out of 4 staff members has a health screening and TB result. LPA advised Administrator regarding the importance of adhering to the facility's corrective action plan that was developed on 07/26/2024 to ensure the facility's stays within compliance of Title 22 regulation. Administrator was reminded of the discussion on 07/26/2024 of the facility being under frequent monitoring inspection visits to ensure compliance with the compliance plan and Title 22 Regulations for 2 years. No deficiencies were cited per California Code of Regulations, Title 22. This report was reviewed with Administrator, Bernellet Taa and a copy of the report was provided.