On 3-4-22, and 6-24-22, citations was issued to facility for reporting requirements, section 87211(a)(1)(B) and section 87211(a)(1) due to not reporting an infectious disease and an elopement episode respectively. Additionally, on 6-24-22, a citation was issued to facility for reporting requirements section 87211(a)(1) due to not informing a responsible party of an elopement episode on 5-15-22. Administrator is aware of timeline for reporting requirements and associated regulation, and has developed a plan in place to ensure compliance going forward.

On 4-13-22 citations were issued to facility for personal rights, section 87468.1(a)(2) due to facility not ensuring a COVID-19 infection symptom screening procedure and sign in policy. Additionally, a citation was issued to facility for personal rights Section 87468(c) for not posting personal rights, discrimination notice, or complaint information prominently. Facility now has a screening process in place which includes a staff member designated to screen all visitors at the front which includes temperature checks and COVID-19 symptom screening questions.

{Cont. on 809C}

On 6-24-22, a citation was issued to facility for medical assessments, section 87458(b)(4) after a resident eloped from facility on 5-15-22 without staffs knowledge. Plan of correction for this citation was to include a reassessment of resident to determine appropriate interventions. Facility has began to audit resident file to determine the need for updated medical assessment including the option for any residents to leave unassisted. Medical assessments have been sent to physicians for signature and facility will follow up. Staff training on AWOL (Absence without leave) to be completed by 9-15-22.

On 6-24-22, a citation was issued to facility for personnel requirements, section 87411(a) due to a staff call off on 5-22-22 resulting in a late medication pass for residents in care. This citation also resulted in a civil penalty. Staffing plan as noted above to be followed.

On 1-5-22, a citation was issued to facility for maintenance and operation, section 87303(a) due to a flooring in bathroom or room #26 in disrepair. Flooring has since been repaired. On 7-15-22, a citation was issued to facility for maintenance and operation, section 87303(a) due to cracked and peeling dry wall in kitchen area. This citation resulted in a civil penalty due to repeat violation within a 12 month period. Administrator stated a maintenance log is in place allowing for requests to be made for any repair needs. An additional system is in place to guide maintenance director towards other routine needs such as temperature checks.

On 7-15-22, a citation was issued to facility for basic service requirements, health and safety code 1569.312(d) due to staff not aware of resident whereabouts after an elopement episode on 7-2-22. On 7-15-22, a citation was issued to facility for medication training requirements, health and safety code 1569(a)(8)(B) due to a staff member assisting residents with medication without proper training on file at the facility. Medication training has been conducted by facility and on-going training will continue. Facility will ensure only appropriately trained staff will handle medication for residents. {Cont. on 809C}

On 7-15-22, a citation was issued to facility for Eviction Procedures, section 87224(a) due to improper 30-day eviction notice issued to resident after an addendum to a previously issued 30-day notice was issued on 7-1-22 resulting in a less than 30-days notice to resident. Facility Administrator has read regulatory section and agrees to comply. In addition, all future eviction notice will be submitted to Department prior to issuance to appropriate parties.

On 8-3-22 citation was issued to facility for Basic service requirements, health and safety code 1569.312(d) due to multiple resident eloping from facility between 5-7-22 and 7-15-22 without staff knowledge of whereabouts. Additionally a citation was issued to facility, section 87211(a)(1)(D) for reporting requirements due to these episodes not reported to licensing per regulatory requirements.

8-12-22 citation was issued to facility for Basic Service requirements, health and safety code 1569.312(d) due to a resident elopement on 8-7-22 without staff’s knowledge of whereabouts. This citation also resulted in a civil penalty issued due to repeat violation within 12-month period. An additional citation was issued on this date for Care of Persons with Dementia section 87705(c)(5) due to licensee not ensuring resident1 (R1) did not have an updated physican’s report as required per regulations. Plan as stated above for ensuring resident whereabouts and updated medical assessments will be followed by facility.

Andrew Chen of DHCS stated he will review necessary documentation and make a determination of compliance with his office.

The following is requested from the department:

1. Administrator is to be available and on-site a minimum of 40-hours per week

2. Updated LIC 309 with organizational chart

3. Updated LIC 308 to note any designated substitutes for Administrator of Record

4. Updated LIC 500

{Cont. on 809C}

6. Department is requesting all future eviction notices are submitted to department prior to issuance to residents and/or their responsible parties

7. Kesha Lewis has been introduced as the new LPA for facility

8. New Administrator Charles White has been introduced as new Administrator of Record for Facility

Department will conduct quarterly unannounced visit to facility in addition to any necessary case management, annual visits, complaints, and other required visits to ensure compliance with above. Department will review the following items including but not limited to:

1. Maintenance logs

2. Medication log sheets

3. Updated AWOL procedures

4. Recent incident reports

5. Random resident medical assessments

6. Training records

7. Facility observation to ensure compliance and safety

LPA Bilger informed Administrator that future non-compliance with the above and other regulatory requirements may result in additional citations and civil penalties as well as an additional non-compliance conference to discuss further administrative actions.

No citation issued today. An exit interview was held with Belinda Guzman and a copy of this report has been read via phone, and will be emailed to Belinda with request for return with signature.