Facility Evaluation Report

Licensing Program Analyst (LPA) C. Lin conducted case management and met with Administrator and program manager and explained the purpose of visit.

On today visit 12/5/22, during the course of investigation on a complaint, the Department observed that Covid-19 outbreak with 5 positive cases started in the facility on 11/27/2022 that was not reported to CCLD. Staff (S7) stated that the outbreak was reported to the county public health in a timely manner, public health has involved and provided further instruction. However, S7 was not aware that reporting to CCLD was required.

A broken door of client's room was observed during visit. Staff S6, S8, and S9 stated that the door has been broken since Thanksgiving, and S7 was not aware of until today's date.

Deficiencies are cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of correction by plan of correction due date and any repeat violation within 12 month period may result in addition civil penalty.

Exit interview conducted with program manager, LIC809D, Appeal Rights, and copy this report provided.