Facility Evaluation Report

While at the facility conducting pre-licensing inspection for change in ownership of this facility and upon review of resident's (R1) record, Licensing Program Analyst (LPA) Delmundo observed the following:

-at 12:30 pm, vitamins and razor in the closet in the resident's room.

-at 1:30 pm, resident (R1) whose LIC602A Physician's Report indicated major neurocognitive impairment and non-ambulatory is in the bedroom fire cleared for ambulatory only.

The above deficiencies were discussed with Mirriam Paras, administrator (ADM).

Deficiencies are cited from Title 22 California Code of Regulations and listed on 809Ds. A $500.00 civil penalties for section # 87202(a)(1) and will continue for $100.00/day until corrected. A $250.00 civil penalty is also assessed for section # 87309(a) for repeat violations within 12 month period and failure to submit proof of correction may result in additional civil penalty.

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

Exit interview conducted. Appeal Rights, LIC421IM and LIC421FCs Civil Penalty Assessments, LIC9098 Proof of Correction form and copy of this report provided.