Follow-up·August 24, 2021

Licensing Program Analyst (LPA) Joanne Roadilla conducted an unannounced Case Management tele-visit at the facility today. The facility is licensed to serve 6 residents 60 years and over, 5 may be non-ambulatory and 1 may be bedridden. The facility has been granted a hospice waiver for four (4). LPA met with Administrator (ADM) Gladys Smart and discussed the purpose of the visit. On 08/19/21, ADM submitted a request for an exception to retain a resident (R1) who has been diagnosed as bedridden and dependent on others for all activities of daily living (ADLs). At 5:35pm, LPA conducted a virtual tour of R1’s shared bedroom via FaceTime with ADM and a facility staff. LPA observed that R1 is not able to reposition and is bedridden. LPA also observed that R1 is not capable of grooming oneself. ADM and staff stated R1 is not able to perform any other ADLs without caregiver assistance. LPA reviewed R1's files including physician's reports (LIC602A), appraisal/needs and services plan (LIC625) and functional capability assessment (LIC9172) and discussed with ADM during the visit. No deficiency cited during today's tele-visit. LPA provided a Technical Assistance during today's tele-visit, see LIC9102. A copy of the report was discussed with and provided to Gladys Smart via e-mail for review and signature.