Incident investigation·October 19, 2022

Licensing Program Analyst (LPA) JoAnn Rosales conducted an Case Management visit at the above facility to investigate incidents that occurred on 10/11/22 and 10/13/22 with resident #1 (R1), R2 and Staff #1 (S1). LPA met with Senior Operations Specialist Michael Fountain. Paperwork has been submitted and recently approved for a change in Administrator to Ronda Wilkin. During today’s visit LPA toured the facility with staff Sharon Friedman and staff Fountain, interviewed random residents and staff, reviewed staff and resident records and obtained copies of pertinent documents. During the facility tour with staff Friedman at 9:51 am LPA observed that S2 was not associated to the facility. S2 stated that they have been working at the facility since it opened. During the facility tour with staff Friedman at 10:04 am LPA observed that S3 was not associated to the facility. S3 stated that they have been working at the facility since 4/6/22. During the facility tour with staff Friedman at 10:12 am LPA observed that S4 was not associated to the facility. S4 stated that they have been working at the facility since 7/20/22. During the facility tour at 10:13 am with staff Friedman and staff Fountain LPA observed a housekeeping cart in the 2nd floor hallway with Folex carpet spot remover, Lemon-Eze bathroom creme cleanser, and Bio-Enzymatic odor elimator accessible to residents as the cart was not locked. LPA did not observe any staff in the area. During the facility tour with staff Fountain at 10:58 am LPA observed hydrogen peroxide, clorox disinfecting mist, barbicide germicide, pseudomonacine, fungicide & virucide liquid, and scissors in an unlocked beauty salon accessible to residents. During the facility tour with staff Fountain at 11:07 am LPA observed that S5 was not associated to the facility. S5 stated that they have been working at the facility since August 2022. While reviewing S1's records LPA observed that S1 was not associated to the facility. While conducting interviews at 2:11 pm LPA observed that S6 was not associated to the facility. S6 stated that they started working at the facility a couple of months ago. Continued on 809C LPA will need to return at a later to continue the investigation. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Civil Penalties issued in the amount of $3,000.00. Exit interview conducted, todays reports, civil penalty and appeals rights were reviewed and emailed to the Administrator and staff Fountain.