Follow-up on corrections·May 22, 2024

Licensing Program Analyst (LPA) Manuel Monter arrived unannounced to open a complaint investigation. During the complaint investigation, a case management deficiencies visit was conducted due to violations discovered during the investigation process. LPA met with Administrator Marsha Belleza LPA entered the facility and asked the staff members their names to cross reference the facility personnel report summary (LIS536), dated May 22, 2024. Staff S1 is not associated to the facility. LPA reviewed S1's name in guardian and S1 is not fingerprint cleared. ADM asked S1 to leave the facility as she is not finger print clear. Staff S1 stated she has been working at the facility for 1 month as kitchen staff and caregiver when needed. Staff S2 is not associated with the facility. S2 stated she has been working at the facility for 9 years. While investigating the complaint (26-AS-20240514090217) dated May 14, 2024, LPA requested to review R1 and R2's physicians report. R1's physician's report states R1 has dementia. ADM stated the physicians report that they have is from when R1 moved to the facility back in 2015. ADM stated she has not updated R1's physicians report. R2's Physicians Report, dated June 2, 2020 states R2 has dementia. ADM stated she has not updated R2's physicians report. LPA requested to review R1 and R2's needs and services plan. R1's needs and services plan is dated September 20, 2017. R1's needs and services plan does not address R1's hoarding toilet paper behavior. LPA requested to review R2's needs and services plan. ADM stated she does not have a needs and services plan for R2. During interview with ADM, ADM stated R2 had wandering behavior. Page 1 Out of 2. Deficiencies are being cited per California Code of Regulations, Title 22. See LIC809-D. A civil penalty is being assessed for the amount of $500 ($100 per day x 5 days = $500) for S1 working in the facility without receiving a criminal record background clearance. Another civil penalty is being assessed for the amount of $500 ($100 per day x 5 days = $500) for S2 working and residing in the facility without association. See LIC421BG. This report was reviewed with Administrator Marsha Belleza and a copy of the report and appeal rights were provided. Page 2 Out of 2 END OF REPORT.