Facility Evaluation Report

At 9:30 a.m. on 08/06/24, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced case management visit. LPA met with staff and disclosed the reason for the visit. LPA and staff toured the facility inside and out.

During the course of investigating complaint #31-AS-20240730093716, multiple deficiencies were observed in the facility which were unrelated to the complaint.

At approximately 9:40 a.m., LPA observed three (03) staff members working in the facility. At 11:45 a.m. LPA reviewed the staff associated to the facility. At approximately 1:45 p.m. LPA called the administrator to confirm the names, start dates, and associations of staff working in the facility. The administrator confirmed that two (02) out of three (03) staff did not have criminal background clearances or associations to the facility. This deficiency is cited on the corresponding LIC 809-D page. In addition, due to Staff #2 (S2) and Staff #3 (S3) working in the facility for longer than one (01) month until today, a civil penalty is issued in the amount of $1,000 ($100 per day, per staff, up to five (05) days) on the corresponding LCI 421BG page.

During the 1:45 p.m. phone interview with administrator, it was revealed that an incident report was not submitted to Community Care Licensing for the hospitalization of Resident #1 (R1) on 07/26/24. This violation of reporting requirements is cited on the corresponding LIC 809-D page.

Exit interview conducted. Appeal rights discussed. Copy of report provided.