Facility Evaluation Report

While at the facility conducting investigation of a complaint (Control # 15-AS-20250825103605), Licensing Program Analyst (LPA) Delmundo observed during inspection, review of records and interviews the following which LPA discussed with Thinn Aye, administrator (ADM).

-no file/record for resident (R1). ADM stated R1 does not have file/record.

-no LIC9020 Register of Facility Clients/Residents

-two residents (R2 and R3) were sent out to the hospital and administrator did not submit LIC624 Unusual Incident Reports.

Deficiencies are cited from Title 22 California Code of Regulations and listed on 809Ds. A $500.00 civil penalty is assessed for deficiency section # 87203. Failure to submit proof of corrections by plan of correction due dates and any repeat violation within 12 month period may result in additional civil penalty.

Deficiencies, plan and proof of corrections and civil penalty were discussed with ADM.

Exit interview conducted. Appeal Rights, LIC421IM Civil Penalty Assessment and copy of this report provided,