Facility Evaluation Report

Licensing Program Analysts (LPAs) Arielle Pascua and Christina Valerio arrived unannounced to this facility to conduct a case management visit. LPAs were greeted by staff member, Andrea Rush and explained the purpose of the visit. LPAs asked that SM Hull contact the Facility Designated Administrator (FDA) at this time to inform them that CCL was present. LPA Pascua spoke to FDA Julian Hawes and it was learned that he was unable to come to the facility at this time and could continue the visit with SM Andrea Rush. There was one other staff member present at the facility, Alma Moyamoy.

Current census was 4. A tour of the facility and a brief interview with SM Rush were conducted

The purpose of this case management visit is to follow up on documentation that was requested by the Audits department.

LPA Pascua requested the following documents:

Copy of the internal investigation completed by the facility involving staff 1 (S1) and a client.

Ledgers and receipts for clients for January 2022 to current for the clients that facility handled their cash resources (P&I)

Procedures for cash handling of client’s P&I, including where clients cash is specifically located.

Copies of physicians report and admission agreements for all clients

LPA Pascua requested that the following documents to be sent to the Audits Department or the LPA's email at arielle.pascua@dss.ca.gov by 06/08/2023 at 5:00pm. Licensee was informed that failure to provide documentation may result in deficiencies.

During the visit LPAs observed that there was a black padlock on the refrigerator door. It was stated by staff that a resident likes to drink milk and juice consistently. LPA reviewed the resident's IPP and confirmed with staff that there is not a plan for the locked refrigerator door at this time.

Based on observations made at today's visit The following deficiencies were cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was provided to the facility via email and an electronic email read receipt confirms receiving these documents.