Facility Evaluation Report

On 07/01/2026 at 10:00 a.m., Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to conduct a Case Management visit. LPA met with care staff Hector Calan and informed him of the purpose of the visit. Mr. Hector notified Administrator (ADM) Madeena Siddiqi by telephone. LPA was unable to speak with ADM because LPA was informed that ADM is currently in the hospital and unable to communicate. ADM later communicated with LPA via text message, granting Mr. Hector permission to sign the report.

While conducting complaint investigation #15-AS-20260604092717, LPA observed that Staff 1 (S1) was not associated with the facility. LPA confirmed with ADM via text that S1 is not associated with the facility and is working to associate S1.

LPA requested documents from ADM to be submitted to LPA on 6/19/26; however, LPA did not receive any of the requested documents. LPA requested the following documents: Four resident admission agreements, Physician’s Reports (LIC 602), Appraisal Needs and Services plans (LIC 625). Facility staff were unable to produce the requested documents at the time of the visit.

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

An exit interview was conducted. A copy of this report and appeal rights was provided.