Facility Evaluation Report

During investigation of complaint (Control # 15-AS-20190926095603) and upon review of resident's (R1) file and review of facility file at Community Care Licensing (CCL) office, Licensing Program Analyst (LPA) Delmundo learned that resident (R1) who has dementia does not have medical assessments for 2018 and 2019. Facility does not have Dementia Care Plan nor have submitted this plan to CCL. These were discussed with Diane Pederson during one of visits when LPA was conducting investigation.

Deficiencies are cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of corrections by plan of correction due dates may result in civil penalty.

Deficiencies and plan and proof of corrections were discussed with Diane Pederson.

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