Atwater Residential Care Facility

Type of visit: Case Management - Other

Licensing Program Analyst's (LPA) Sarah Hurt and Darius Williams conducted an unannounced Case Management visit. LPA's met with facility Assistant Administrator, Airen Miro and explained the purpose of the visit. LPA's toured the facility including facility including kitchen, indoor, and outdoor areas. The facility has sufficient food supply, and is clean in good repair. LPA's observed two facility staff present assisting residents. LPA's observed one facility care staff cleaning the facility, and doing residents laundry. LPA's discussed a plan with facility Assistant Administrator for the backyard seating arrangement. No Deficiencies cited today Per Title 22 Regulations. Exit interview conducted with facility Assistant Administrator, Airen Miro and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, Nov 6, 2023

Allegation investigated: Staff did not meet a resident's incontinence needs while in care Staff did not prevent a resident from causing harm to other residents Staff did not properly reports incidents involving a resident Staff are not providing adequate care and supervision to a resident Staff mishandled a resident's medication while in care Staff is not following the admission agreement

Licensing Program Analysts (LPA's) Sarah Hurt and Darius Williams conducted an unannounced visit to the facility to deliver investigation findings. LPA’s met with Licensee Jessica Johnson over the phone and explained the purpose of today’s visit. Regarding the allegation, Staff did not meet a resident's incontinence needs while in care. LPA Hurt observed several photos documenting Resident 1’s buttocks area to be extremely red and irritated. Medical records document Resident 1 had erythema and pain in the buttocks area. Based on records reviewed during this investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED at this time. Continued.... Substantiated Regarding the allegation Staff did not prevent a resident from causing harm to other residents. Incident Report dated 03/13/2023 documents Resident 1 assaulted two other facility residents. LPA Hurt reviewed several text and email exchanges between facility Administrator and Resident 1’s Responsible Party documenting incidents of Resident 1 hitting other facility residents. Based on records reviewed the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED at this time. Regarding the allegation Staff did not properly report incidents involving a resident. LPA Hurt reviewed medical records documenting Resident 1 was taken to the hospital on 02/06/2023, this incident was not reported to State Licensing. LPA Hurt observed text messages dated March 4, 2023 documenting Resident 1 assaulted another facility resident. This incident was not reported to State Licensing. This incident from March 4, 2023 was not reported to State Licensing. Based on records reviewed during this investigation the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED at this time. Regarding the allegation Staff are not providing adequate care and supervision to a resident. LPA Hurt reviewed Incident Report dated 03/13/2023 documents Resident 1 assaulted two other facility residents. Staff 1 stated at times working alone with 4 residents providing all care and supervision, meals, and incontinent needs made it difficult to provide supervision. Based on records reviewed during this investigation the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED at this time. Regarding the allegation Staff mishandled a resident's medication while in care. LPA reviewed Centrally Stored Medication log for Resident 1 documenting a medication with a start date of 01/01/2023 with no quantity, date filled, expiration date, or Pharmacy name. The medication is not documented on any Medication Administration Record. It is unclear if this medication was given to Resident 1 at the facility. Based on LPA observation, and records reviewed during this investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED at this time. Regarding the allegation Staff is not following the admission agreement. Admission agreement documents under section “Notice of Rate Changes." If the facility rate for basic services changes because the resident’s needed/desired services changes as determined by an appraisal (see resident appraisals / evaluation of your needs), the rate change will occur when the change in service occurs, as long as at least thirty days have passed since the signing of the admission agreement. We shall provide the resident or the representative a written itemized notice of a rate increase after the change in services which will include a detailed itemized explanation of the additional services to be provided. Responsible Party for Resident 1 was not given a detailed itemized explanation of the additional services provided. The invoice provided is not dated. Based on Records reviewed during this investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED at this time. The following Deficiencies are being Cited Per Title 22 Regulations. Exit interview conducted with Licensee Jessica Johnson, and a copy of this report provided. Continued.. Regarding the allegation Resident sustained multiple injuries while in care. Resident 1 did have documented bruising during a visit to his Physician on 02/13/2023. Resident 1 also had documented un-witnessed falls. Facility staff documented Resident 1 was refusing to use his wheelchair, and walker. Based on the interviews conducted, documentation obtained and reviewed, and the information received during this investigation, the preponderance of evidence standard has not been met; therefore, the above allegation is found to be unsubstantiated at this time. Regarding the allegation Staff disclosed confidential information. Licensee did text Responsible Party for Resident 1 asking if their contact information can be given to the Responsible Parties of other residents. Resident 1’s Responsible party was not contacted by any other residents Responsible Parties. Based on the interviews conducted, documentation obtained and reviewed, and the information received during this investigation, the preponderance of evidence standard has not been met; therefore, the above allegation is found to be unsubstantiated at this time. Regarding the allegation Staff are falsifying a resident's medical records. Facility staff documented Resident 1’s medication given three times daily once at 4 p.m. despite Resident 1 leaving for the hospital at approximately 3 p.m. Facility staff did give Resident 1 his medication as listed on the prescription despite it not being the exact time. Based on the interviews conducted, documentation obtained and reviewed, and the information received during this investigation, the preponderance of evidence standard has not been met; therefore, the above allegation is found to be unsubstantiated at this time. Regarding the allegation Staff did not provide an authorized representative access to resident records. LPA reviewed text messages between Resident 1's Responsible Party, and Licensee Jessica Johnson discussing Resident 1's records. Based on these messages it is unclear when the documents were originally requested, and who requested the records. A written request was not given to Licensee requesting Resident 1's records. Based on the interviews conducted, documentation obtained and reviewed, and the information received during this investigation, the preponderance of evidence standard has not been met; therefore, the above allegation is found to be unsubstantiated at this time. No Deficiencies Cited Per Title 22 Regulations. Exit interview conducted with Licensee Jessica Johnson, and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 25, 2023 · control 24-AS-20230320135406

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.2 · Plan of correction due date: Oct 26, 2023

(c) “Care and supervision” means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered. Assistance includes assistance with taking medications, money management, or personal care. The following requirement has not been met as evidenced by: Resident 1 attacked several other facility residents which poses an immediate health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 25, 2023

Plan of correction: Licensee will provide training to all facility staff on Care and Supervision of residents, and provide proof to LPA by POC date of 10/26/2023.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Oct 26, 2023

87465 Incidental Medical and Dental Care(a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. The following requirement has not been met as evidenced by: Resident 1's Centrally Stored Medication Log lists medications with no quantity which poses an immediate, health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 25, 2023

Plan of correction: Licensee will submit a plan documenting how she is going to ensure residents medications will be refilled, dispersed and provided to residents per physician’s orders by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.657(a) · Plan of correction due date: Nov 9, 2023

§1569.657 Rate increase due to change in level of resident care; notice (a) For any rate increase due to a change in the level of care of the resident, the licensee shall provide the resident and the resident’s represent ative, if any, written notice of the rate increase within two business days after initially providing services at the new level of care. The notice shall include a detailed explanation of the additional services to be provided at the new level of care and an accompanying itemization of the charges. The following requirement has not been met as evidenced by: Licensee did not provide Resident 1's responsible party a detailed written breakdown of services provided , and it is not clear when invoice was given, which poses a potential, health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 25, 2023

Plan of correction: Licensee will re submit invoice #100 to include a detailed explanation of additional services to provided at the new level of care and accompanying itemization of the charges to CCL by POC date of 10/24/2023.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87265(b)(7) · Plan of correction due date: Oct 26, 2023

87265 Managed Incontinence (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (7) Ensuring that the condition of the skin exposed to urine and stool is evaluated regularly to ensure that skin breakdown is not occurring. The following requirement has not been met as evidenced by: Records, and photos document Resident 1's buttocks area was extremely red and irritated over a period of weeks, which poses an immediate, health, safety or personal rights risk to resident in care.the state’s words, verbatim · CDSS document, Oct 25, 2023

Plan of correction: Licensee shall provide documentation and training on how staff will evaluate residents regularly to ensure skin breakdown is not occurring and submit proof to LPA Hurt by POC date 10/26/2023.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(1)(D) · Plan of correction due date: Nov 2, 2023

87211Reporting Requirements e shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. The following requirement has not been met as evidenced by: LPA reviewed records of incidents on 03/09/2023 that was not reported to State Licensing which poses a potential, health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 25, 2023

Plan of correction: Licensee will submit proof of regulation understanding to LPA Hurt by POC date of 11/02/2023.

Type of visit: Case Management - Other

Licensing Program Analysts (LPA's) Sarah Hurt and Vadim Gorban conducted an unannounced Case Management visit. LPA’s met with facility Licensee Jessica Johnson and explained the purpose of today’s visit. LPA's walked around and toured the facility resident bedrooms, backyard area, kitchen, and common areas. LPA Hurt provided Licensee with Licensing form 311F LPA Hurt provided Licensee with Community Care Licensing / Medications Guide No Deficiencies Cited today Per Title 22 Regulations. Exit interview conducted with Licensee Jessica Johnson, and a copy of this report provided.the state’s words, verbatim · CDSS document, Oct 10, 2023

Type of visit: Case Management - Deficiencies

Regional Manager (RM), Licensing Program Manager (LPM) Brenda Chan, and Licensing Program Analysts (LPA's) Sarah Hurt conducted a Case Management (Office) visit. RO, LPM, and LPA met with facility Administrator Jessica Johnson and explained the purpose of today's visit. LPA observed Resident 1's medications pre poured in a labeled weekly medication dispenser. LPA requested records for Resident 1 during a Case Management visit to the facility on 09/12/2023. Licensee Jessica Johnson stated she does not have a file for Resident 1 “because she is new.” LPA requested the file for Resident 1 be provided by 09/15/2023. Licensee has not provided the file for Resident 1. Licensee submitted staff training documents Due to Technical Difficulties this report was not signed by Licensee Jessica Johnson during the visit. The following Deficiencies are being cited Per Title 22 Regulations. Exit interview conducted with Licensee Jessica Johnson, and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 21, 2023

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(4) · Plan of correction due date: Sep 22, 2023

87465Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (4) All centrally stored medications shall be labeled and maintained in compliance with state and federal laws. No persons other than the dispensing pharmacist shall alter a prescription label. (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers. Based on LPA observation the facility was dispensing medications not in their orignally marked containers to Resident 1 which poses an immediate, health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 21, 2023

Plan of correction: Licensee will conduct medication training with all facility staff, and submit proof to LPA Hurt by 09/22/2023 POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87506(a) · Plan of correction due date: Sep 22, 2023

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. The following requirement has not been met as evidenced by: Based on observation the Licensee does not have resident records in a location readily available to Licensing staff.the state’s words, verbatim · CDSS document, Sep 21, 2023

Plan of correction: Licensee will provide all requested resident records to LPA by 09/22/2023 POC date.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(6)(A) · Plan of correction due date: Sep 22, 2023

(6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes:(A) The name of the resident for whom prescribed. (B)The name of the prescribing physician. (C) The drug name, strength and quantity. (D) The date filled. (E) The prescription number and the name of the issuing pharmacy. (F) Instructions, if any, regarding control and custody of the medication. The following requirement has not been met as evidenced by: LPA Hurt observed Resident 1 does not have a centrally stored medication log which poses an immediate, health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 21, 2023

Plan of correction: Licensee will provide centrally stored medication log for Resident 1 by 09/22/2023 POC date.

Type of visit: Case Management - Other

Licensing Program Analysts (LPA's) Sarah Hurt and Brianna Miranda conducted an unannounced facility visit conduct a Case Management visit. LPA's were greeted by facility staff Octavia Mceva and allowed entry into the facility. LPA's spoke with Licensee Jessica Johnson over the phone and explained the purpose of today's visit. LPA's requested complete files for Resident 1, and Resident 2 including most recent Physician's Report, Needs and Services Plan, Emergency face sheet, and any incident reports by end of business day on September 15, 2023. LPA's requested Pre - Admission Appraisal, and Physicians Report for Resident 3. LPA's previously requested current Personnel Report (LIC 500). Licensee has yet to submit. LIC 500 needs to be submitted by end of business day on September 15, 2023. LPA's delivered notification of Non- Compliance Conference to be held in the Fresno Regional Office (1314 E. Shaw Ave., Fresno CA, 93710) at 10:00 a.m. on September 21, 2023. LPA's informed this meeting is to be held in person and not online. Non-Compliance Conference letter was left with facility staff Octavia Mcvea. Licensee Jessica Johnson requested facility staff Octavia Mcvea not sign the report. No Deficiencies Cited today per Title 22 Regulations Exit interview conducted with Licensee Jessica Johnson over the phone and a copy of this report provided.the state’s words, verbatim · CDSS document, Sep 12, 2023

Allegation investigated: Staff are not trained medication management Facility is not ensuring residents health related needs are met

Licensing Program Analysts (LPA's) Sarah Hurt and Lisa Salazar conducted an unannounced facility visit conduct a Case Management visit. LPA's met with facility staff Octavia Mcvea and explained the purpose of today's visit. Regarding the allegation Staff are not trained medication management. The Licensee was not able to provide medication training for Staff 1 to LPA's Hurt and Salazar for review. Based on LPA's observation during this investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED at this time. Substantiated Continued.. Regarding the allegation Facility is not ensuring residents health related needs are met. Licensee was not present at the facility during the visit. Facility staff present was not able to provide Resident 1's records. LPA's Hurt and Salazar observed Staff 1 started on 08/31/23 and is caring for Resident 1 without access to "Needs and Service" plan. Based on LPA's observation during this investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED at this time. The following Deficiencies are being Cited Per Title 22 Regulations. Exit interview conducted with Licensee via telephone and a copy of this report was left at the facility. The Licensee stated the staff present during the visit is not her listed designee and should not sign the report.the state’s words, verbatim · CDSS document, Sep 1, 2023 · control 24-AS-20230831094129

From the deficiency page — Deficiency type: Type A · Section cited: HSC 1569.69(2)(f) · Plan of correction due date: Sep 5, 2023

§1569.69 Employees assisting residents with self-administration of medication; training requirements (2) In facilities licensed to provide care for 15 or fewer persons, the employee shall complete 10 hours of initial training. This training shall consist of 6 hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and 4 hours of other training or instruction, as described in subdivision (f), which shall be completed within the first two weeks of employment. This requirement was not met as evidenced by LPAs request for staff and resident files. Licensee was unable to provide files and proof of training at the time of visit. Interviews with staff reveal the required documented training was not conducted. If not corrected, This poses an immediate risk to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Sep 1, 2023

Plan of correction: Licensee will provide proof of staff training to LPA Hurt by 09/05/2023 POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458(b)(1) · Plan of correction due date: Sep 8, 2023

(b) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the physician's primary diagnosis and secondary diagnosis, if any...other medical conditions which would preclude care of the person by the facility. This requirement was not met as evidenced by LPAs interview with Licensee and staff stating resident file is not available at the time of visit. Staff began employment on 08/30/23 at 4:30pm and does not currently have access to residents care plan which poses a potential health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 1, 2023

Plan of correction: Licensee will provide Resident 1's file to LPA Hurt by 09/08/2023 POC date.

Allegation investigated: Staff was unable to communicate due to language barrier Staff are not properly maintaining resident’s medical records

On 07/28/2023, Licensing Program Analysts(LPA's) Sarah Hurt and Lisa Salazar arrived at the facility unannounced to conduct an initial 10-day complaint inspection. LPAs met with facility Licensee Jessica Johnson announced the purpose of the inspection. Regarding the allegation Staff was unable to communicate due to language barrier.LPA's observed facility Staff 1 present during visit is unable to communicate with licensing staff or facility residents as she does not speak English. Based on LPA's observation during this investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED at this time. Continued on 9099C.. Substantiated Continued from 9099... Regarding the allegation staff are not properly maintaining resident’s medical records. Licensee was unable to provide requested records for Resident 1. Licensee stated the records were not provided with Resident 1 at the time of Admission on July 14, 2023. Based on LPA's interviews during this investigation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED at this time. The following deficiencies are being cited per Title 22 Regulations. Exit interview conducted with Licensee Jessica Johnson. A copy of this report along with appeal rights provided.the state’s words, verbatim · CDSS document, Jul 28, 2023 · control 24-AS-20230725122932

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: Jul 29, 2023

87411Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. The following requirement has not been met as evidenced by: LPA's observed Staff 1 did not speak english, and was unable to communicate with Licensing staff, and facility residents, which poses an immediate health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 28, 2023

Plan of correction: Licensee agrees to have staff present at all that can communicate with facility residents and send proof to LPA by POC date of 07/29/2023.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87506(a) · Plan of correction due date: Jul 29, 2023

87506 Resident Records (a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. The following requirement has not been met as evidenced by: Based on interviews with Licensee, Resident 1 does not have any records and non were provided at the time of Resident 1's admission, which poses an immediate health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 28, 2023

Plan of correction: Licensee agrees to provide requested records for Resident 1 and send proof to LPA by 07/29/2023 POC date.

Type of visit: Required - 1 Year

Licensing Program Analysts (LPA) Sarah Hurt, and Les Xiong conducted an unannounced visit today for the facility’s annual inspection. LPA met with Facility staff Vicenta Martinez Continual Administrator's Certification for Jessica Johnson expires 06/06/2023. There are currently residents 4 who reside at this home and there is 2 residents on hospice at this time. LPA inspected the interior and the exterior of the facility including the common living spaces, resident bedrooms and bathrooms, activity rooms, medication storage, kitchen, garage and outdoor areas. Bedrooms were clean and in good repair. There is a locked storage for medications. Food supply is adequate for 2-day perishable and 7-day nonperishable. Smoke alarms were tested and are operational. The home has a carbon monoxide detector and performs disaster drills as required. Water temperature was tested at 114 degrees. First Aid kit is on site and complete. Toxins and cleaning supplies are locked and inaccessible. LPA's Hurt and Xiong reviewed Resident 1's Physician Report. Resident 1 is bedridden, and the facility does not have fire clearance for bedridden residents. LPA's observed knobs on kitchen stove with functioning knobs accessible to residents. LPA's observed the south backyard gate to be locked. LPA's observed Resident 2's Centrally Stored Medication log did not have current prescription information. LPA's observed the facilities door alerts leading to outside not functioning. The following deficiencies observed or cited during today's inspection per California Code of Regulations, Title 22. LPA's requested the following documents: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing. Exit interview conducted with facility staff, Vicenta Martinez and copy of report left at facilitythe state’s words, verbatim · CDSS document, May 17, 2023

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Facility accepted a resident who requires a higher level of care

Licensing Program Analyst (LPA) Sarah Hurt and David Ayers conducted an unannounced facility visit to open a complaint investigation. LPA's met with facility Licensee Jessica Johnson and explained the purpose of today's visit. During the course of the investigation, the department conducted interviews, reviewed documentation, and toured the facility. Based on interviews and documentation, Resident 1(R1) was admitted to the facility on 11/23/2022. Based on records review, R1 was admitted without a complete pre-admission appraisal. R1's Needs and Services Plan was also incomplete. Based on interviews, the facility did not have proper eqipument to meet R1's needs. The allegation is Substantiated. See attached 9099D for citation issued in accordance with California Code of Regulations Title 22. Exit iterview conducted with Licensee. Substantiatedthe state’s words, verbatim · CDSS document, Mar 24, 2023 · control 24-AS-20221201135742

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87464(d) · Plan of correction due date: Apr 7, 2023

(d) A facility need not accept a particular resident for care. However, if a facility chooses to accept a particular resident for care, the facility shall be responsible for meeting the resident's needs as identified in the pre-admission appraisal specified in Section 87457, Pre-admission Appraisal and providing the other basic services specified below, either directly or through outside resources. Based on records reviewed, the Licensee did not ensure that a proper pre-admission appraisal was completed prior to admitting R1. During interview, R1 stated that their needs were not met by the facilit staff. This results in a potential health and safety risk for residents in care.the state’s words, verbatim · CDSS document, Mar 24, 2023

Plan of correction: Licensee agreed to write a statement which states they will conduct a proper pre-admission appraisal and needs and services plan for any resident admitted in the future and submit to CCLD by 4/7/2023.

Allegation investigated: Staff did not provide the resident’s representative written notice of the rate increase within two business days after initially providing services at the new level of care Staff did not refund authorized representative after resident's passing Staff refused to allow authorized representative in the facility to pick up residents belongings Staff did not provide a comprehensive description of any items and services provided under a single fee, such as monthly fee for room, board and other items and services shall be listed in the admission agreement

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to conduct a complaint investigation. LPA Hurt met with Administrator Jessica Johnson and explained the purpose of today's visit. Regarding the allegation Staff did not provide the resident’s representative written notice of the rate increase within two business days after initially providing services at the new level of care. The facility Admissions Agreement documents under section "Notice of Rate Changes." We shall provide the resident or the representatives a written itemized explanation of the additional services provided. Resident 1's responsible party stated they were given the written description through email on 11/18/2022 after the verbal notification of increased rate on 11/04/2022. Based on facility records reviewed, and interviews conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Continued on 9099C.... Substantiated ....Continued from 9099 Regarding the allegation staff did not refund authorized representative after resident's passing. The facility Admission's Agreement documents under "Death of a Resident." Within fifteen days after your personal property is removed from the facility, your estate, or other person or entity responsible for payment of fees and charges under this Agreement will receive a refund any fees paid in advance covering the period after your personal property has been removed. The licensee shall, within 3 days of becoming aware of a residents death, provide a written notice to specified persons of the facility's policies regarding contract termination at death and refunds. The facility Administrator Jessica Johnson has not provided a refund to Resident 1's Responsible Party more than 15 days after their passing. Based on facility records reviewed, and interviews conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Regarding the allegation Staff refused to allow authorized representative in the facility to pick up resident’s belongings. After the passing of Resident 1 on 11/12/2023 the facility Administrator Jessica Johnson did not allow Resident 1's responsible party to enter the facility on 11/13/2022 to gather their belongings. The facility Admission's Agreement documents "Upon your death, your personal property is removed at any time by appointment or between the hours of 8 a.m. to 5 p.m. Monday through Friday, by your responsible person, by other persons whom you have designated in writing in this Agreement, or by a court appointed executor or administrator of your estate, if applicable. Based on facility records reviewed, and interviews conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Regarding the allegation Staff did not provide a comprehensive description of any items and services provided under a single fee, such as monthly fee for room, board and other items and services shall be listed in the admission agreement. Based on interviews conducted the facility Administrator Jessica Johnson did not provide a description of services provided under a single fee until 11/18/2022, 14 days after the higher rate began for these services and she was verbally notified on 11/04/2022 . Based on facility records reviewed, and interviews conducted the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. The following deficiencies are being cited today Per Title 22 Regulations. Exit interview conducted with facility Administrator Jessica Johnson, and copy of report provided along with appeals rights provided.the state’s words, verbatim · CDSS document, Feb 27, 2023 · control 24-AS-20221115100653

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(f) · Plan of correction due date: Mar 14, 2023

87507((f)The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. The following requirement has not been met as evidenced by: The facility Administrator did not provide written notice of rate increase within two days as stated in signed facility Admissions Agreement, which poses a potential, health, safety or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 27, 2023

Plan of correction: Administrator Jessica Johnson will provide written Statement of Understanding of Regualtion 87507 (f) and submit to LPA Hurt by POC date of 03/14/2023.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.652(a) · Plan of correction due date: Mar 14, 2023

Health and Safety Code section 1569.652 provides in part:(a) A residential care facility for the elderly shall not require advance notice for terminating an admission agreement upon the death of a resident. No fees shall accrue once all personal property belonging to the deceased resident is removed from the living unit. The following requirement has not been met as evidenced by: Resident 1's responsible party has not been refunded after passing on 11/12/2023 which poses a potential health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 27, 2023

Plan of correction: Administrator Jessica Johnson will issue refund to Resident 1's responsible party for pro rated days after his passing and submit proof to LPA by POC date of 03/14/2023.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(g)(A)1. · Plan of correction due date: Mar 14, 2023

87507 Admission Agreement (g) Admission agreements shall specify the following:(1) Basic services, as defined in Section 87101(b), (A) Rate for all basic services which the facility is required to provide in order to obtain and maintain a license. Basic services rate(s), including: 1A comprehensive description of any items and services provided under a single fee, such as monthly fee for room, board and other items and services shall be listed. The following requirement has not been met as evidenced by: Administrator did not give detailed itemized description of fees until 14 days after change of condition and rate increase, which poses a potential, health, safety, or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Feb 27, 2023

Plan of correction: Administrator Jessica Johnson will provide written Statement of Understanding of Regualtion 87507 (g)(A) and submit to LPA Hurt by POC date of 03/14/2023.

Type of visit: POC

Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced virtual POC visit with facility Administrator Jessica Johnson to verify correction of citations issued during the Case Management visit conducted on 12/07/2022. Administrator Jessica Johnson acknowledged the $1,300 holding fee charged has not been refunded to reporting party mentioned in case management conducted on 12/07/2022 and complaint case # 24-AS-20220914194055. Deficiency cited on 12/07/2022, Deficiency Section 87507(g)(3)(C) Any fee that is charged prior to or after admission, shall be clearly specified has not yet been cleared. Licensee has not complied with the terms of the POC by POC due date of 12/21/2022. Exit interview conducted with Administrator Jessica Johnson and a copy of this report was provided via email.the state’s words, verbatim · CDSS document, Jan 6, 2023

Type of visit: Case Management - Deficiencies

On 12/07/2022, Licensing Program Analyst (LPA), Sarah Hurt conducted an unannounced Case Management visit, was greeted by Licensee Jessica Johnson, and announced reason for the visit. Licensee was informed that during a recent investigation conducted by LPA, Alexandria Walton, it was observed that the facility charged a $1300 fee to hold a room in August 2022 and when the resident did not end up moving into the facility, the fee was not refunded to the responsible party (RP). This holding fee was not specified in the admission agreement as required by Title 22 regulation, as cited in the attached 809D. The following Deficiencies are being cited Per Title 22 Regulations. An exit interview was conducted and a copy of this report and appeal rights were provided to Licensee Jessica Johnsonthe state’s words, verbatim · CDSS document, Dec 7, 2022

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(g)(3)(C) · Plan of correction due date: Dec 21, 2022

Section 87507(g)(3)(C) Any fee that is charged prior to or after admission, shall be clearly specified. **This requirement was not met as evidenced by review of the admission agreement provided to RP, that did not specify a $1300 holding fee.the state’s words, verbatim · CDSS document, Dec 7, 2022

Plan of correction: Licensee will submit proof of refund of the holding fee to the RP within a reasonable timeframe such as 30 days and amendment of the admission agreement to include all fees and the refund provisions for each by 12/21/2022 POC date.

Type of visit: Case Management - Other

On 09/26/2022, Licensing Program Analyst contacted Administrator, Jessica Johnson via telephone. LPA introduced self, stated the purpose of the call and requested to speak with the Administrator. LPA spoke with Administrator, Jessica Johnson. On 09/23/2022, due to a technical issue, a citation for background clearance was not issued. The purpose of this report is to issue the citation for the deficiency that was observed during the inspection on 09/23/2022, when LPA observed an uncleared staff in the facility. A deficiency is being a cited in accordance to California Code of Regulations, Title 22, Division 6. A civil penalty was assessed on 09/23/2022 in the amount of $100. Exit interview was conducted. A copy of this report and appeal rights will be provided to Administrator, Jessica Johnson, via email and an electronic read receipt confirms receipt of this document.the state’s words, verbatim · CDSS document, Sep 26, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(1) · Plan of correction due date: Sep 27, 2022

87355(e)(1): Obtain a California clearance or a crminal record exemption as required by the Department... This requirement was not met as evidenced by: Based on observation, Licensee did not ensure all staff obtained a California clearance or a criminal record exemption when S1 was present in the facility without a California clearance which poses an immediate health and safety risk to persons in carethe state’s words, verbatim · CDSS document, Sep 26, 2022

Plan of correction: Licensee agrees to submit a written statement detailing the facility's plan to ensure the requirements of section 87355(e)(1) are met to the Fresno CCL office by the POC due date.

Type of visit: Case Management - Deficiencies

This is an amended report. On 09/23/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct a case management – deficiencies visit. LPA introduced self, stated the purpose of the visit and was granted entry to the facility. LPA met with Administrator, Jessica Johnson. The purpose of this visit is to follow up on an incident reports submitted to the Fresno CCL office. Upon entry to the facility, LPA observed an uncleared staff working in the facility. Per ADM, S1 has worked in the facility for training yesterday, 09/22/2022 and is currently in training today 9/23/2022. LPA informed ADM that S1 is not cleared and cannot work in the facility until S1 receives fingerprint clearance and is associated to the facility. Regarding the incident that was reported to the Fresno CCL office, Administrator (ADM) reported that on 8/28/2022, R1 left the facility after repeated attempts to redirect R1, and entered a neighboring home, resulting in ADM calling law enforcement. Additionally, R1’s personal rights were violated when ADM administered PRN medications to R1 while R1 was restrained. Based on interviews with ADM, deficiencies are being cited in accordance with the California Code of Regulations, Title 22 , Division 6 on the attached 809D. An immediate civil penalty is being assessed in the amount of $500 for Care and Supervision on the attached LIC421IM and an immediate civil penalty in the amount of $100 is being assessed for Caregiver Background Check on the attached LIC421BG, for a total of $600. Exit interview conducted and a Plan of Correction was reviewed and developed with ADM. A copy of this report was discussed and provided to Administrator, Jessica Johnson, whose signature on this form confirms receipt of this document This is an amended report.the state’s words, verbatim · CDSS document, Sep 23, 2022

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Sep 27, 2022

(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. Based on interviews, Licensee did not ensure all residents were provided care and supervision when on 08/28/2022, R1 was able to "bypass" facility staff, exit the facility, and enter a neighboring home unsupervised, which poses an immediate health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Sep 23, 2022

Plan of correction: Licensee agrees to submit a written statement detailing the steps the facility will take to ensure the requirements for section 87468.2 are met to the Fresno CCL office by the POC due date. Licensee agrees to train all staff on requirements of Additional Personal Rights of Residents in Privately Operated Facilities by 10/14/2022. Evidence of training topics and attendance will be submitted to the Fresno CCL office by 10/14/2022.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87465(a)(5)(D) · Plan of correction due date: Sep 27, 2022

(a) A plan for incidental medical and dental care shall be developed by each facility…. (5) Assistance with self-administered medications shall be limited to the following: (D) Assistance with self-administration does not include forcing a resident to take medication, hiding or camouflaging medications in other substances without the resident's knowledge and consent, or otherwise infringing upon a resident's right to refuse to take a medication. This requirement was not met as evidenced by: Based on interviews, the Licensee did not ensure that the requirements for the section 87465(a)(5)(D) on 08/28/2022 when ADM administered PRN medications to R1 while R1 was restrained. This poses an immediate health and safety risk to residents in carethe state’s words, verbatim · CDSS document, Sep 23, 2022

Plan of correction: Licensee agrees to submit a written statement detailing how the facility will ensure the requirements for the above section are met to the Fresno CCL office by the POC due date.

Allegation investigated: Staff did not refund fees to resident who decided not to enter the facility

This is an amended report. On 09/21/2022, Licensing Program Analyst (LPA) Walton conducted an unannounced complaint investigation visit. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. Facility staff contacted Administrator via telephone, and she was unable to attend but gave LPA verbal permission to meet with Caregiver, Arlene Angeles. LPA delivered findings of the complaint, whose signature on the original report, confirms receipt. Today, 11/16/2022, LPA Walton and Licensing Program Manager (LPM) Melinda Hoffmann contacted Administrator via telephone and informed her that the report is being amended as follows. CONTINUED TO 9099C Substantiated This is an amended report. During the course of the investigation, LPA interviewed Administrator, Resident #1's (R1) responsible party (RP), and reviewed records, including but not limited to the admission agreement provided to RP. Based on interviews and records review, a preadmission appraisal was not completed by facility, resident did not end up moving into the facility, and as of 9/21/22, facility had not issued a refund of the $500 preadmission fee. The preponderance of evidence standard was met and the allegation: Staff did not refund fees to resident who decided not to enter the facility was SUBSTANTIATED. A deficiency was cited in accordance with California Code of Regulations, Title 22, Division 6 on the attached 9099D. Administrator was informed that a copy of this report will be emailed to her for signature, as will a clearance letter for the above deficiency as it has been verified that the refund of $500 was issued to RP subsequent to the deficiency.the state’s words, verbatim · CDSS document, Sep 21, 2022 · control 24-AS-20220914194055

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87507(g)(5)(E) · Plan of correction due date: Oct 14, 2022

(g) Admission agreements shall specify the following...(5) Refund conditions...(E) Preadmission fees shall be refunded according to the following conditions: 1. A 100 percent refund of a preadmission fee shall be provided to an applicant or the applicant’s representative if: a. The applicant decides not to enter the facility prior to the facility completing a preadmission appraisal...b. The licensee fails to provide full written disclosure of preadmission fee charges and refund conditions. This requirement was not met as evidenced by: Based on interviews and records review, the facility did not ensure 100 percent of the $500 admission fee was refunded to R1, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Sep 21, 2022

Plan of correction: Licensee agrees to refund $500 to R1 by the POC due date and submit proof that refund was given to the Fresno CCL office. Licensee agreed to submit a signed written statement acknowledging that the Licensee will amend the facility admission agreement to include language regarding holding fees and the terms for refund and said language must be in accordance with section 87507.

Type of visit: Case Management - Other

On 09/01/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct a case management visit. LPA introduced self, stated the purpose of the visit, and requested to meet with the Administrator. Administrator, Jessica Johnson, is not available to attend this visit. Administrator was contacted via telephone. LPA received verbal permission to meet with Caregiver, Norma Ceja. The purpose of today's visit is to follow up on an incident reported to the Fresno CCL office and return the complete file for R1 that was removed from the facility on 08/31/2022. No deficiencies issued during today's inspection. Exit interview conducted. A copy of this report was discussed and provided to Caregiver, Norma Ceja, whose signature on this form confirms receipt of this document.the state’s words, verbatim · CDSS document, Sep 1, 2022

Type of visit: Case Management - Incident

On 08/31/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an case management inspection. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Administrator, Jessica Johnson. The purpose of today's visit is to follow up on an incident report that was submitted to the Fresno CCL office. LPA reviewed resident and staff records during this visit. LPA is removing the complete file for R1 for the purpose of review and copying and will return the file within 3 business days. No deficiencies issued during today's visit. Exit interview was conducted. A copy of this report was discussed and provided to Administrator, Jessica Johnson, whose signature on this form confirms receipt of this document.the state’s words, verbatim · CDSS document, Aug 31, 2022

Type of visit: POC

On 07/13/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct a POC visit. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. Facility staff contacted Administrator via telephone. LPA met with Administrator, Jessica Johnson, who arrived a short time later. LPA amended a report that was created on 06/17/2022. On 06/17/2022, the above facility received a citation based on California Code of Regulations section 87465 (a)(4): Licensee shall assist residents with self - administered medications. LPA and Administrator, Jessica Johnson developed a plan of correction where Licensee agreed to submit a written statement detailing the facility’s plan to meet the requirements of section 87465 by 06/20/2022. LPA returned to the above facility on 06/30/2022 and spoke with Administrator, Denise Ordonez via telephone. LPA informed Administrator that a civil penalty in the amount of $100 per day was being assessed until the Plan of Correction (POC) was submitted to the Fresno CCL office. Administrator, Jessica Johnson submitted the POC to the Fresno CCL office on 07/08/2022. A civil penalty is being assessed for the failure to correct CCR 87465(a)(4) for the period of 06/21/2022 through 07/07/2022 (17 days) in the amount of $100 per day, for a total of $1,700, see form LIC421FC. An exit interview was conducted. A copy of this report and appeal rights were discussed and provided to Administrator, Jessica Johnson, whose signature on this form confirms receipt of this document.the state’s words, verbatim · CDSS document, Jul 13, 2022

Type of visit: POC

On 06/30/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct a Plan of Correction (POC) inspection. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. Facility staff contacted Administrator, Denise Ordoniez via telephone. LPA waited for approximately 1 hour for Administrator to arrive. Administrator did not arrive during the inspection, LPA met with Caregiver, Angely Soltero. On 06/17/2022, LPA conducted a Post-Licensing inspection at the above facility. LPA issued a citation based on California Code of Regulations section 87465 (a)(4): Licensee shall assist residents with self-administered medications. Licensee did not have 2 medications prescriptions filled in the facility that were listed on the MAR for R2 and did not administer 8 days of medications for R1. LPA and Administrator, Jessica Johnson developed a plan of correction where Licensee agreed to submit a written statement detailing the facility’s plan to meet the requirements of section 87465 by 06/20/2022. As of today, Licensee has not submitted the plan of correction to the Fresno CCL office. A civil penalty is being assessed in the amount of $100 per day until the plan of correction is submitted to the Fresno CCL office. Exit interview conducted. A copy of this report and appeal rights were discussed and provided to Caregiver, Angely Soltero, whose signature on this form confirms receipt of this document.the state’s words, verbatim · CDSS document, Jun 30, 2022

Type of visit: Post Licensing

This is an amended report. On 06/17/2022, Licensing Program Analyst (LPA) A. Walton arrived unannounced to conduct a Post-Licensing Inspection. LPA introduced self, stated that purpose of the visit and was granted entry to the facility. LPA met with Assistant Administrator, Denise Ordonez and Administrator, Jessica Johnson. Facility currently has 3 residents in care. LPA conducted a tour inside and outside the facility with Administrator. Facility observed to be clean, odor free, and at a comfortable temperature. The dining room and living room were furnished well with adequate seating and lighting. Resident rooms appeared clean and had all required furnishings. 1 bedroom is single occupant, the second resident bedroom is shared, beds were observed to be at least 6 feet apart. LPA observed an adequate supply of linen. Facility has an adequate supply of PPE and cleaning supplies. Resident bathrooms were properly equipped with securely fastened grab bars and non-skid mats. Bathrooms were stocked with liquid soap and paper towels. Hand-washing signs observed by bathroom sinks. Hot water in 3 bathrooms measured between 109.3 - 119.3 degrees F. Kitchen toured, appeared clean, observed a 7-day supply of non-perishable foods. Facility did not have a 2-day supply of perishable food. Knives/Sharps observed to be locked in the medication cabinet. Exterior tour conducted, all exits open and free of obstructions. Side gate was observed to be self-latching. Fire extinguisher serviced on 03/21/2022. Smoke detectors and carbon monoxide detectors observed operational during today’s inspection. Facility has not conducted a fire drill as of this date. All chemicals observed to be locked and secure laundry room. Medications observed to be locked in a cabinet in the kitchen. LPA reviewed resident records and medications. Review of medications revealed that R1 has not received R1's medication of Sertraline HCL 50MG for the past 8 days. MARs observed to be signed off as given. LPA observed that R2 is missing 2 PRN medications, Acetaminophen and Hyosclamine. LPA reviewed personnel files for first aid and criminal record clearance. Administrator has been unable to provide documentation for proof of staff training. Deficiencies are being cited in accordance to California Code of Regulations, Title 22, Division 6 on the attached 809D. Exit interview conducted with Administrator. A Plan of Correction was reviewed and developed with Administrator. A copy of this report and appeal rights were discussed and provided to Administrator, Jessica Johnson, whose signature on this form confirms receiving this document.the state’s words, verbatim · CDSS document, Jun 17, 2022

Type of visit: Case Management - Other

On 03/23/2022, Licensing Program Analyst (LPA) A. Walton conducted an announced Case Management Inspection. LPA Walton introduced self, stated purpose of visit, and was allowed entry into the facility. LPA met with: Licensee: Jessica Johnson Administrator: Amish Munshi The purpose of this visit is to follow up on the corrected items identified during the Pre-Licensing Inspection dated 03/16/2022. LPA conducted a tour with Licensee and Administrator. The smoke detector has been attached to the ceiling in bedroom 3 and carpet has been secured in bedroom 3. Grab bars have been installed by the bathroom toilets. Additional linens was observed in the hallway closet. Hot water measured between 109.2 - 116.0 degrees F. Fire extinguisher was last serviced on 03/21/2022. I have found that the applicant has met all pre-licensing requirements. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued. Exit interview conducted. A copy of this report was discussed and provided to Licensee, whose signature on this form confirms receipt of this document.the state’s words, verbatim · CDSS document, Mar 23, 2022

The state marks this report as 2 pages; the online copy we transcribed has 1. You can request the full file from the county licensing office.

Type of visit: Prelicensing

On 03/16/2022, Licensing Program Analyst (LPA) A. Walton conducted an announced Pre-Licensing / Component III inspection. LPA Walton introduced self, stated purpose of visit, and was allowed entry into the facility. LPA met with: Licensee: Jessica Johnson Administrator: Denise Ordoniez The facility is a 3 Bedroom and 3 Bathroom home and fire clearance was granted for 2 Ambulatory and 2 Non-Ambulatory for a total of 4 Capacity. LPA toured the facility with Licensee. Common areas were furnished and had adequate seating and lighting available. Bedrooms had required furnishings and are ready for occupancy. LPA observed the smoke detector in bedroom 3 to be detached from the ceiling. The carpet in bedroom 3 was observed to be lifted from the floor and not fully installed. Hot water measured at 129.3 degrees F in the bathroom in bedroom 3, 124.2 degrees F. in the hallway bathroom and 111.3 degrees F. in the Activity bathroom. Grab bars observed to be in the shower area, no grab bars observed by the toilet. LPA observed a short supply of bed linens and an adequate personal hygiene products. Kitchen was toured and observed to have dishes, plates, and utensils. Cleaning supplies and chemicals were observed to be locked in the laundry room. Medications will be locked in a cabinet in the kitchen. First aid kit was observed and contained all required items. A fire extinguisher was observed and did not have a service date. Smoke detectors and carbon monoxide were observed to be operational during this inspection. Outside of facility toured. Exits were open and free of obstructions. LPA observed side gate to be self-latching. CONTINUED TO LIC809C LPA requested Licensee to correct the following items: Reattach smoke detector to the ceiling in bedroom 3 Secure the carpet to the floor in bedroom 3 Adjust water heater to allow facility water temperature to be within range Have fire extinguisher serviced Obtain additional bed linens to permit changing for once per week that includes blankets and bedspreads. Install grab bars near the toilets Component III was conducted during today’s pre-licensing visit. Exit interview conducted. A copy of this report will be provided to Licensee via email due to COVID-19 precautionary measures. Report signed on-site by facility representative. LPA will notify CAB that facility is ready to be licensed once the above information has been received.the state’s words, verbatim · CDSS document, Mar 16, 2022