Facility Evaluation Report

On 7/19/2024 At 11:40 AM, Licensing Program Analysts (LPAs) L.Hall and Ardalan Gharachorloo conducted an unannounced Case Management visit regarding an request for change of administrator that was submitted to CCLD on 7/9/2024. LPA met with Wilma Carvaja, Director Support Professional, Ryan Carvajal, arrived at 11:55am and explained the purpose of the visit.

LPAs conducted a case management visit at another facility where it shows the same Administrator for this facility also LPAs arrived to confirm administrator certification. This facility does not have a certified administrator at this time. LPAs observed during visit and record review that S2, S3, S4, were not associated to the facility.

Deficiencies are cited per Title 22 California Code of Regulations and listed on LIC 9099D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12- period may result in civil penalties month

Exit interview conducted. A copy of the appeal rights and this report provided.