Facility Evaluation Report

During the course of investigation of a complaint (Complaint Control # 15-AS-20220301161043), and upon review of resident's (R1) LIC621 Client/Resident Personal Property And Valuables, Licensing Program Analyst (LPA) Delmundo observed this document does not have the cell phone, iPad and other electronic items that were purchased for R1 listed. LPA had a discussion with Millicent Dizon, administrator, who stated that as administrator she should have the items listed.

Deficiency is cited from Title 22 California Code of Regulations, and listed on 809D Failure to submit proof of correction by plan of correction due date, and any repeat violation within 12 month period may result in civil penalty

Deficiency and plan and proof of correction were discussed with the administrator over the phone. Administrator authorized Melinda Balingit to sign and receive this report.

Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.