Facility Evaluation Report

On 6/28/23 at 2:30 PM, Licensing Program Analyst (LPA) Malia Thao conducted a case management - deficiencies inspection. LPA met with Licensee/Administrator (LIC) Jonathan Johnson and Facility Manager (MAN) Nicole Morehead.

During the inspection for complaint #24-AS-20230622113235, LPA found the following deficiencies:

1. R1 returned to the facility from the hospital last week with a new order for use of oxygen gas administration and the facility did not create a written care plan for R1.

2. R1 and R3 do not have health screening records. R3 does not have TB results. R1 has been working since 4/26/23 and R3 has been working since 6/8/23.

3. R2 and R3 do not have proof of initial training. R2 has been working in the facility since 5/19/23 and R3 has been working since 6/8/23.

Deficiencies are being cited based on LPA observations, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22, see LIC809D.

An exit interview was conducted and Plans of Corrections were reviewed and developed with the Licensee. A copy of this report and appeal rights were discussed and left with Licensee Jonathan Johnson, whose signature on this form confirms receipt of these documents.