Facility Evaluation Report

Licensing Program Analyst (LPA) Araceli Canela arrived unannounced to conduct a case management visit and gather information/records regarding a self reported incident by the facility on 2/9/2024 that involved staff S2, S3, S4 and resident R1. LPA met with Executive Director /Administrator , Jasmine Seiffert , took statement and requested records for Community Care Licensing to review incident.

In addition LPA returned to issue citations that were observed on 2/2/2024 during a complaint investigation, but LPA was unable to issue citations due to time restraints. On 2/2/2024 LPA discovered staff S1 who had been working, was fingerprint cleared, but was not associated to this facility as required. In addition LPA found resident R1 and R2 who have a Dementia Diagnoses to have items such as a cup filled with some type of vitamins, a sharp knife, bottle of window cleaner and a hammer. R1 and R2 are not in memory care unit, but occupy a room in assisted living. On 2/2/2024, LPA along with staff S2 removed the items from the residents rooms and placed them inaccessible. LPA went over such items with Administrator during the visit.

During today's visit LPA went into R1 and R2s bedroom and did not observe any vitamins or sharp items; a bottle of cleaning solution and the hammer where in the top shelf, inaccessible to R1.

The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and appeal of rights provided.