Facility Evaluation Report

While at the facility investigating a complaint (Control # 15-AS-20250808113155) and upon review of residents' files and interviews, Licensing Program Analyst (LPA) Delmundo learned that resident (R1 and R2) LIC602A Physician's Reports are outdated. R1's LIC602A was dated 1/09/17 and showed R1 able to bathe, dress/groom and feed self and care for own toileting needs; however, R1's condition has changed and is now dependent on the staff on all activities of daily living. R2's LIC602 dated 4/14/24 indicated ambulatory but R2 uses walker to ambulate.

Deficiencies are cited from Title 22 California Code of Regulation, and listed on 809Ds. Failure to submit proof of corrections by plan of correction due dates and any repeat violations within 12 month period may result in civil penalties.

Deficiencies and plan and proof of corrections were discussed with the ADM.

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