Facility Evaluation Report

On 11/3/21 at 10:00 AM, Licensing Program Analyst (LPAs) Malia Thao and Lisa Salazar arrived unannounced to conduct a case management - deficiencies inspection.

LPAs observed the following deficiencies:

1. Steak knife out on the counter in the kitchen of the third floor, unsupervised. LPA Malia Thao observed food service staff walk out of kitchen/dining room, then LPAs entered kitchen/dining area with LVN Faith Enriquez and observed steak knife out on counter. While touring the memory care unit, LPAs observed from the hallway a disinfecting spray bottle on top of toilet tank in Room 244. Room 244's door was open, and disinfecting spray was accessible to room's resident as well as all other passing residents.

2. LPA found that R2 is diagnosed with dementia and last had a medical assessment completed on 2/20/2020.

3. R6's medical assessment form LIC602A did not include the resident's primary or secondary diagnosis.

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

Exit interview conducted. A copy of this report and appeal rights were emailed to email on record with Read receipt to confirm receipt of this report.