Incident investigation·January 27, 2023

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a Case Management Inspection and met with Rosie Ascencio. Licensee, Leah Archer was available by phone and gave permission for caregiver to sign report. LPA is following up on a new admission of resident (R1) who appears to have some behavioral tendencies. LPA obtained a copy of R1’s care plan, admission agreement and pre-appraisal. LPA/staff toured the facility and observed that R1 have their own room and they are ambulatory. Licensee is worked closely with their Responsible Party discussing the options available for R1’s behavioral plan to ensure that all residents are protected and it was agreed by both parties after a meeting conducted on January 19, 2023 that the facility is not a good fit for R1. On 1/26/23 CCL received a 30-day unlawful eviction notice email. During today's visit, LPA discussed with Licensee the eviction process regulation and Licensee agreed to re-issue the eviction notice with corrected items. LPA also requested to review current LIC500 Personnel Report and Licensee told LPA that the facility file was not available in the facility for LPA to review which is not in compliance with Title 22 regulation. Per Licensee, she is ensuring to have adequate staffing at all times to meet needs of all residents in care. LPA observed two staff providing care and supervision to residents in care. Licensee agreed to submit updated LIC500 to CCL for LPA’s review. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.