Facility Evaluation Report

Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a Plan of Correction (POC) visit. LPA met with Licensee and explained the purpose of the visit.

During complaint investigation conducted November 5, 2024, facility was cited 87555 General Food Service Requirements with POC due date of November 12, 2024. LPA received an email of the requested POC on November 18, 2024. POC has been cleared and letter was generated. $600 failure to correct by due date civil penalty assessed.

Additionally, LPA cleared the following deficiencies that was issued during a case management visit conducted on November 5, 2024 and corrected in a timely manner, POCs has been cleared and letter was generated for the following:

LPA and Licensee discussed the following POCs that is still accruing as POC has not been received and has exceeded its due date:

- §1569.312 Basic services requirements Type A violation POC due date of November 6, 2024 which facility is to submit a plan of how facility will ensure residents in care will not leave the facility unassisted/unnoticed. $1,300 failure to correct civil penalty has been assessed and will continue to accrue $100 per day until plan is received.

- 87405 Administrator - Qualifications and Duties Type B violation POC due date of November 15, 2024 which Licensee and Administrator are to review the provided handouts of CCR 87458 Medical Assessment

and CCR 87506 Resident Records and notify LPA once it has been completed. $400 failure to correct civil penalty has been assessed and will continue to accrue $100 per day until notification is received.

Exit interview, a copy of the report and civil penalty appeal rights provided.