Facility Evaluation Report

Licensing Program Analyst (LPA) Teresa Camara conducted an unannounced Case Management – Deficiencies visit on 03/24/2022, in conjunction with complaint control # 29-AS-20200522094856. LPA met with facility administrator Serguei Kalistratov and explained the reason for the visit.

During the course of the investigation of the above noted complaint, it was discovered the administrator failed to do the following:

-obtain a hospice care plan for Resident #1 (R1) or retain any hospice records

-report R1 entering into hospice to Community Care Licensing (CCL)

-complete a reappraisal for R1 after R1’s hospital stays and change in condition

-report two incidents when R1 was admitted to the hospital.

Pursuant to Title 22 Division 6 Chapter 8 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 to administrator at serguei35@yahoo.com