Routine inspection (multi-day)·January 4, 2024

Licensing Program Analysts (LPAs) Steve Chang and Manuel Monter conducted an unannounced case management visit- Annual continuation visit to inspect and evaluate the resolution for the prior deficiencies. LPAs met with Administrator (ADM) Jean Jose. LPA's observed 6 residents and two staff. LPAs toured and inspected the garage, bedrooms and bathrooms. No residents were observed resides in the garage. LPAs reviewed the resident files. LPAs reviewed and discussed the Plan of Correction with Administrator (ADM). The following deficiencies and plan of corrections were reviewed and cleared during the visit. Type A, 87202 Fire Clearance (a) This deficiency was cited on December 14, 2023. During today's visit, LPA's observed the garage not being used as a bedroom for residents or staff. LPA's also received the facility's plan of correction letter, which also included the pictures of the converted garage (office). Type A, 87468.1 Personal rights of Residents in All Facilities (a)(1) This deficiency was cited on December 14, 2023. LPA received the facility's plan of correction letter. Type A, 87207 False Claims, This deficiency was cited on December 14, 2023. LPA received the facility's plan of correction letter. Type A, 87405 Administrator Qualifications and Duties (d)(1)(2) This deficiency was cited on December 14, 2023. LPA received the facility's plan of correction letter. Page 1 out of 2. Type A, 87204 Limitations Capacity and Ambulatory Status (a) This deficiency was cited on December 14, 2023. During today's visit, LPA's observed the facility had only 6 residents and the converted garage was not being used as a bedroom for staff or residents. The facility provided their plan of corrections. Type B, 87303 Maintenance and Operation(e)(5) - This deficiency was cited on December 14, 2023. During todays visit, LPA's observed the facility bathtubs and showers had non-skid mats. LPA also received the facility's plan of action, with photo showing the bathroom adjacent to the laundry room has a non-skid mat. LPA reviewed facility records for 8 residents. LPA reviewed 8 resident medications and centrally stored medication records. During a review of resident R3's records, LPA could not find R3's admission agreement. LPA's asked ADM for R3's admission agreement. ADM stated she doesn't know where it is and does not have a copy. A deficiency is being cited during today's visit. This report was reviewed with ADM Jean Jose and a copy of the signed report was provided. Appeal rights were provided.