Facility Evaluation Report

While at the facility investigating a complaint (Control # 15-AS-20260113155055) and upon review of residents' records and interviews, Licensing Program Analyst (LPA) Delmundo learned that resident's (R1) LIC625 Appraisal/Needs and Services Plan was not updated when R1 was issued a restraining order. LPA also learned R2 is able to leave the facility unassisted and able to come back without incidence but R2's LIC602A Physician's Report indicated not able to. LPA discussed these with Joseph Crisol, administrator (ADM) and informed that citations will be issued.

Deficiencies are cited from Title 22 California Code of Regulations and listed on 809D. Failure to submit proof of corrections by plan of correction due dates and any repeat violation within 12 month period may result in civil penalty.

Deficiencies and plan and proof of corrections were discussed with ADM over the phone. ADM stated he cannot come to the facility and authorized Kenneth Lal to sign and receive this report.

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