Facility Evaluation Report

On 4/9/2025 at 10:15AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct Case Management - Annual Continuation. LPA met with caregiver, Julie Ann Arcosa and explained the purpose of the visit. Administrator, Marivel Calambro was not able to be at the facility and authorized caregiver to sign CCLD reports.

During visit, LPA reviewed 5 residents and 3 staff files. LPA observed staff are fingerprint cleared and associated to the facility. LPA reviewed a sample of resident's medications at around 3:00PM.

At 11:30AM, LPA observed R1 and R3 did not have admission agreement on file.

At 11:35AM, LPA observed the five residents (R1, R2, R3, R4, R5) did not have reappraisal/ needs & service plan on file.

At 11:40AM, LPA observed R2 did not have medical assessment on file.

At 1:00PM, LPA observed all staff does not have initial and annual training on file.

At 3:30PM, LPA observed facility did not have MAR (Medication Administration Records) completed for March and April of 2025. MARs for April was missing for all residents and MARs for March was incomplete. LPA observed staff did not mark down when medications were given and PRN medications were not documented on the MARs.

The deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and Health & Safety Code. Failure to correct the deficiencies may result in civil penalties.

Exit interview conducted with Julie Ann Arcosa. A copy of this report and appeal rights were provided.