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25 | On 11/22/2022 at 10:20 AM Licensing Program Analyst (LPA) L. Ibo arrived unannounced to conduct a Case Management regarding death report received on 11/17/2022. LPA met with Caregivers S3 & S4. The staff called the Administrator Marnie Mejia. LPA spoke with Marnie Mejia, LPA informed Administrator the purpose of the visit. At around 11:00AM, licensee Kevin Braud arrived at the facility, at around 11:10am facility nurse consultant (NC) arrived at the facility. At around 12:10PM Administrator arrived at the facility.
LPA toured the facility’s inside and outside. During the tour and staff interview, LPA observed the following;
1. Medication drawer was observed to be unlocked and key was hanging on the medication drawer, which was accessible to clients in care.
2. S6 was not associated at the facility.
3. Staff did not conduct covid19 screening to LPA upon entering the facility. Technical assistance provided.
During the case management visit, LPA gathered documents such as but not limited to; LIC500, LIC9020, staffing schedule, copy of C1’s doctor’s order, C1’s physician’s report, C1’s individual program plan (IPP), facility nurse notes and C1’s care plan.
Due to insufficient information at this time, LPA will conduct additional interviews and documents reviews. LPA will return to the facility.
Deficiency is cited from Title 22 California Code of Regulations and listed 809D. Failure to submit proof of correction by plan of correction due date may result in civil penalty.
Exit interview conducted. A copy of this report and appeal rights provided.
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Deficiency Type
POC Due Date /
Section Number | DEFICIENCIES | PLAN OF CORRECTIONS(POCs) |
Type A
11/22/2022
Section Cited
CCR
80087(g)
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7 | Buildings and Grounds
(g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients.
This requirement is not met as evidenced by: | 1
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7 | Staff locked the medication drawer/cabinet during inspection. |
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14 | Based on observation and interview the licensee did not comply with the section cited above. LPA observed unlocked medication drawer/cabinet, that were accessible to clients which poses an immediate health, safety or personal rights risk to persons in care. | 8
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14 | Administrator agreed to retrain staff and submit proof of in-service training to CCL by 11/24/2022. |
Type B
11/23/2022
Section Cited
CCR80019(e)(2)
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7 | 80019 Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 80019(f)
This requirement is not met as evidenced by: | 1
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7 | Administrator agreed to associate S6 to facility before staff starts to work. |
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14 | Based on record review and interview, the licensee did not comply with the section cited above by not having staff, S6, associated to the facility which poses a potential safety risk to persons in care. | 8
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14 | Administrator agreed to send proof of association to LPA by 11/23/2022. |