Facility Evaluation Report
On 07/01/2026, at 10:30am Licensing Program Analyst (LPA) T. Syess-Gibson conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 06/25/2026. LPA met with Assistant Executive Director, Simone Hall, and explained the purpose of the visit.
The incident report received stated that staff were doing rounds and observed Resident 1 (R1) knee was swollen and R1 complaining of pain in right knee. Facility sent R1 to hospital for evaluation. Facility has noted R1 had multiple unwitnessed falls the day before incident. LPA reviewed and obtained the following documents: Resident’s roster, R1’s, Physician’s Report (LIC602), face sheet, assessment and service plan dated 06/22/2026, and after visit summary dated 06/12/2026. LPA also interviewed staff during visit.
Exit interview conducted. A copy of this report was provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction