Follow-up·December 30, 2021

Licensing Program Analyst (LPA) Arlene Garcia arrived at this facility unannounced to conduct a case management visit. LPA met with Miesha Cooper, Caregiiver S1 and explained the purpose of the visit. LPA Garcia toured the facility with S1. COVID wellness check conducted. Sufficient PPE supplies. LPA observed comfortable living accommodations. LPA observed 2-day perishable and 7-day non-perishables. LPA observed lights functional. During this visit, it appeared that staff was sufficient. S1 reported there was a sufficient number of staff. S1 reported S1 gets paid on time. S1 reported S1 had no issues or concerns. LPA advised S1 that the Department is performing Golden Age facilities 3 rd quarter, 2021 financial monitoring review. LPA requested the Administrator provide the following documents for period July - September / 2021. Administrator AD to submit to the Department no later than the close of business day on Monday January 3rd, 2022 . 1. LIC 401/401A Form for the month of September 2021. 2. LIC 403/403 A Form for the month of September 2021. 3. All utility monthly billing statements including cable, water, garbage, electricity and gas for the period from July 2021 to September 2021. 4. Monthly Bank Statements for period from July 2021 to September 2021. 5. All food receipts for all the facilities for period from July 2021 to September 2021 6. Rental Roll including resident name and rental payment for the period from July 2021 to September 2021. Exit interview conducted with S1. . Copy of report provided.