Office review·March 8, 2022

A virtual Informal Conference was conducted today. The purpose of this Informal Conference is to discuss the failure to report a COVID-19 outbreak at the facility in February 2022. In attendance included Licensing Program Manager (LPM) Kristin Heffernan, Licensing Program Analyst (LPA) JoAnn Rosales, Administrator SanJuana Enriquez and Operations Manager Matteo DiGrigoli. LPM Heffernan discussed substantiated complaints and citations issued from the past three years. LPM Heffernan discussed how the Administrator plans to stay in compliance and the best ways to work with the Department for additional support and assistance. The Operations Manager indicated that they are almost fully staffed at this point and that they have delegated the reporting to their new Wellness Director. The Operations Manager stated that they will have staff conduct room sweeps and when doing rounds to keep eyes out for chemicals or any other hazardous items. The Operations Manager stated that they have placed numerical locks on doors to medications or hazardous items that auto lock when closed. The Operations Manager stated that before they hire anyone they will be checking the Guardian portal to make sure that are eligible for association to the facility. The Administrator was informed that Community Care Licensing (CCL) shall continue to monitor the facility with inspection visits as often as necessary to ensure the Licensee's compliance with Title 22 Regulations. The Administrator was also informed that further citations and/or non-compliance may result in a Non-Compliance Conference with the Regional Manager and review with CCL's legal division for further actions warranted. Exit interview conducted and copy of today's report was provided to the Administrator.