Facility Evaluation Report

On 7/3/2024 at 3:00pm, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct a Case Management visit. LPA met with Noupane Temple, Administrator, and explained the purpose of the visit.

LPA received a request for a hospice waiver increase on 6/28/2024. LPA was informed the facility had retained the resident before requesting the waiver. LPA will issue a citation for the facility not requesting the waiver before retaining the resident.

The following deficiencies were also observed during the visit:

At 3:10pm, LPA observed medications sitting on the kitchen table and counter top. LPA also observed scissors accessible to residents.

At 3:20pm, LPA observed during record review S2 not fingerprinted or associated to the facility.

Deficiency is cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties.

*An immediate $500.00 civil penalty was assessed on today's date for fingerprint*

Exit interview conducted. A copy of the appeal rights, LIC421BG, and this report provided.