Community Care Licensing

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LPA Albert Johnson made an unannounced POC visit to the facility to verify correction of citations issued during the complaint investigation conducted on 1/24/24 . LPA toured the facility, reviewed document submitted for plans of correction observed that the deficiencies cited on 01/24/24 have been cleared. Deficiencies cited under Title 22 Regulations have been cleared. Licensee complied with the terms of the POC by POC due date. Facility was provided POC cleared letter. Section Cited: 87468.1 Date Due: 01/25/2024 Plan of Correction: Licensee is to ensure that all inservice trainings are documented and residents' personal rights are upheld at all times. Corrections: Cleared By Visit Clearance Date: 04/11/2024 Section Cited: 87468.2(a)(4) Date Due: 03/06/2024 Plan of Correction: The facility has completed the in service training fro Personal rights. The plan of correction was completed on 1/25/2024. Corrections: Cleared By Visit Clearance Date: 04/11/2024 Exit interview conducted

SUPERVISOR'S NAME: Lisa Rios TELEPHONE: (916) 969-9685 LICENSING EVALUATOR NAME: Albert Johnson TELEPHONE: (916) 217-1390 LICENSING EVALUATOR SIGNATURE: DATE: 04/11/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/11/2024