Facility Evaluation Report

On 04/12/23 at 10:05 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to deliver complaint finding for #15-AS-20211028125726. A case management is being conducted and LPA met with Emily Aliping, Co-Administrator (Co-ADM) and explained the reason.

The “After visit summaries” for R2 revealed the following on the noted dates: On 07/07/21, overdue visits for COVID-19 vaccine (2-Pfizer 2 dose series); overdue since 02/21/21, postponed to 05/19/21 and 07/02/21. The Shingles vaccination sequential (2 of 2) was overdue since 03/19/21. On 08/04/21, ophthalmology visit was rescheduled for R2 by S1. Proof of R1, R2, and R3’s dental and ophthalmology exams, and/or attempts to schedule exams were not provided to CCL by 03/24/23 when requested from S1 on 02/16/23.

Deficiency is cited per California Code of Regulations, Title 22, and listed on LIC 809D. Failure to submit Proof of Corrections (POC's) by Plan of Correction date and/or repeat deficiencies within

12-month period may result in civil penalties .

Exit interview conducted, Appeal Rights and a copy of this report provide to Co-ADM,