1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25 | At approximately 11:45AM, Licensing Program Analyst (LPA) Felias arrived unannounced to continue a Required 1 Year visit and met with Staff Member, Sally Menke, and Licensee, Silvana Daniel. Upon arrival, LPA was informed that there were 6 residents in care and one staff member on-site.
At approximately 12:00PM, LPA reviewed the Facility's Staff Roster and found that all staff on-site were background cleared and associated to the facility per regulation. LPA reviewed staff and resident files and resident medication. Resident files were all found to be well organized, thorough and contained the required documentation. Staff files had current First Aid and CPR certification. LPA observed that staff members had 2022 annual training, but were missing 2023 annual training per Health and Safety Code (this deficiency has been cited, see LIC809D, Health and Safety Code 1569.625(b)(2)). Medication was observed to be centrally stored and secure. Administrator's Certificate for Licensee Silvana Daniel (6003231740) was current with an expiration date of 03/21/2025.
LPA requested the following documents to update facility file:
- Designation of Facility Responsibility (LIC 308)
- Emergency Disaster Plan (LIC 610D)
- Updated Personnel Report (LIC 500)
- Register of Clients/Residents (LIC 9020)
- Updated Liability Insurance
Documents to be submitted to Community Care Licensing (CCL) by due date of 05/16/2024.
Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Exit interview conducted. Plan of Corrections reviewed and developed with Licensee. Copy of report, LIC809D, and Appeal Rights discussed and provided to Licensee. Signature on form confirms receipt of documents. |