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25 | Licensing Program Manager Bethany Moellers, Licensing Program Analyst Carla Fernandes-Goes met with Kathleen Olson - Acting Executive Director, Sue McPherson - VP of Regulatory , Mark Maclaine - Vice President of Operations for Novato, Jimmy Duong - Regional Health Service Director Specialist. This meeting was conducted virtually due to COVID-19.
This meeting is being conducted to transfer a Compliance Plan Conference which started on July 2, 2021 due to facility new ownership. The following concerns were identified by the Licensing Agency in regard to the operation of this facility including but not limited to: Complaint investigations that have been substantiated and other concerns that have been observed such as:
Ø Medications: Facility had residents with unlocked medications in their possession who were not allowed to store and/or dispense medications according to physician's reports on file.
Ø Prohibited Conditions: Facility retained a resident with a prohibited condition
Ø Timely Medical Attention: Facility failed to seek timely medical attention.
Ø Medical Assessments: Facility failed to ensure that resident's medical assessments/physician's report is complete as required.
Ø Resident Records: Facility wasn't able to provide CCLD with pre-appraisals for resident's files that were reviewed.
Ø Staffing: Facility memory care didn't have adequate number of direct care staff to support each resident's physical, social, emotional, safety and health care needs.
Ø Facility Food Services:
Ø Reporting Requirements: Facility failed to report refusal of medications, 911 calls, suspected abuse, etc.
The Regional Office will re-review progress made on Non-Compliance Plan of 2 years from July 2, 2021.
Continued LIC 809-C |