Facility Evaluation Report

Licensing Program Analysts (LPAs) Ashley Smith and Elsie Campos conducted an unannounced Case Management-Deficiencies inspection visit at the facility today due to deficiencies observed during the investigation of complaint control # 29-AS-20211203112208.

During today’s investigation, the LPAs observed that the facility did not have the required Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) for resident observation.

At 1:55 p.m., the LPAs observed wine accessible in the Discovery Room.

At 1:59 p.m., the LPAs observed gardening tools and planting soil in the outdoor courtyard.

During the file review, the LPAs audited the file for Staff #1 (S1) and noted that S1 was not associated to the community. After reviewing the Caregiver Background Check System, it was noted that S1 was separated from the community on 10/5/2021. A review of timecards and schedules for S1 confirmed that S1 worked at least eleven (11) days from 11/1/2021 – 11/31/2021 without appropriate clearance.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D):

Exit interview conducted, today's reports and appeal rights were reviewed and issued. Civil penalties assessed.