Facility Evaluation Report

On 10/27/2023 at 11:00 AM, Licensing Program Analyst (LPA) Melody Brown met with Licensee/Administrator Evafe Green - Sosnovsky and Administrator Russel Bernardo at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office to initiate a Case Management Office Visit. LPA Brown explained the purpose of the requested Office Visit. The investigation consisted of interviews and a review of pertinent documentation.

On 10/23/2023, LPA Brown received Personnel Report Summary (LIC500) from Administrator Russel Bernardo and LPA Brown observed that no staff are scheduled to work on a night (NOC) shift. LPA Brown immediately address the issue with S2. LPA Brown explained to Administrator Bernardo that per Title 22 Regulation 87705 Care of Persons with dementia, their facility must have at least one night staff person awake and on duty if any resident with Dementia is determined through a pre-admission appraisal, reappraisal or observation to require awake night supervision. Interview with Staff #2 (S2) during the visit on 10/23/2023 indicated that the facility have two (2) residents with dementia and two (2) residents with mild cognitive impairment. S2 verbalized understanding during the visit on 10/23/2023 and updated the facility's LIC500 showing S2 as staff coverage on night (NOC) shift. On 10/27/2023, LPA Brown informed Licensee/Administrator Evafe Green - Sosnovsky and Administrator Russel Bernardo that deficiency will be issued as this pose immediate health, safety and personal rights risk to residents in care.

Moreover, per review of R1's Physician Report (LIC602), LPA Brown observed that the facility failed to complete the required annual medical assessment, reappraisal and reassessment done for R1's dementia care needs. LPA Brown informed Staff #1 (S1) and S2 that deficiency will be issued as this pose potential health, safety and personal rights risk to residents in care.

An exit interview was conducted where this report LIC809, 809D and Appeal Rights were discussed and provided to Licensee/Administrator Evafe Green - Sosnovsky and Administrator Russel Bernardo.