Correction check·December 12, 2023

Licensing Program Analyst (LPA) Christi Coppo arrived unannounced to conduct a Case Management- POC and was greeted by Chey Ilan, Administrator and Clayton Anderson, Licensee. Facility currently has five (5) residents in care. On 11/07/2023 facility was cited for not complying with Title 22 regulation 87705(5) in [3] out of [5] resident records with a diagnosis of dementia, their respective LIC602s were not current within 12 months . LPA discussed with Administrator failure to satisfy plan of correction by due date of 11/28/2023. As of today, the respective LIC602s have not been made current and as such the plan of correction (POC) to correct deficiency has not been corrected. A civil penalty of $100 per day shall be assessed beginning the day after the POC due date of 11/29/2023. The Civil Penalty will continue to accrue at $100 per day until the deficiency is corrected. On 11/07/2023 LPA requested facility send updated LIC500 within 30 days. As of today, 12/12/2023 updated LIC500 has not been received by CCLD. Per LPA interview with Administrator, the only staff currently working with residents are herself and Clayton Anderson, Licensee. Administrator confirmed there are no overnight awake staff currently working. Per Title 22, regulation 87705(c)(4)(A) Care of Persons with Dementia - Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (4) There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her current appraisal. (A) In addition to requirements specified in Section 87415, Night Supervision, a facility with fewer than 16 residents shall have at least one night staff person awake and on duty if any resident with dementia is determined through a pre-admission appraisal, reappraisal or observation to require awake night supervision ( deficiency cited, see 809D ). Per LPA interview with Administrator, the only staff currently working with residents is herself and Clayton Anderson, Licensee; however, Licensee does not have current training hours completed. Per Title 22, regulation 87411(c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 ( deficiency cited, see 809D ). Continued on 809C... Continued from 809... Per LPA interview with Administrator and Licensee, the room on facility sketch designated as a commonly used living room is currently being used as a sleeping room for non-client resident (NCR1). Per Title 22, regulation 87307(a)(2)B) Personal Accommodations and Services- No room commonly used for other purposes shall be used as a sleeping room for any resident. This includes any hall, stairway, unfinished attic, garage storage area, shed or similar detached building ( deficiency cited, see 809D ) Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit: LIC500- Personnel Report Copy of Deed or Mortgage Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Licensee. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with Administrator and a copy of this report was given.