Facility Evaluation Report

At approximately 9:15AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to continue a Required-1 Year inspection. LPA met with Administrator Maria Bui and reviewed Staff and Resident records. At approximately 9:30AM, LPA reviewed 5 of 5 resident files. 3 of 5 resident appraisals were not completed within the last 12 months. 1 of 5 physician reports was not completed within the last 12 months and there was no documentation of a refusal. At approximately 10:00AM, LPA conducted a review of medications. Medication is locked and not accessible. LPA observed medication was prepared several days in advance. LPA discussed regulation regarding transferring medication between containers. At approximately 10:30AM, LPA reviewed 6 staff files. Staff files reviewed did not contain current evidence of completed annual training in 5 of the 6 files. First Aid/CPR certification was current.

Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit:

Evidence of control of Property, (Current Rental/Lease Agreement/Deed)

LIC308- Designation of Facility Responsibility

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

This report was reviewed with Administrator and Appeal rights were given.