Facility Evaluation Report

On 09/24/2025 at 2:30 PM, Licensing Program Analyst (LPA) L. Alexander arrived unannounced at the facility to conduct a Case Management visit. Upon arrival, LPA met with Executive Director (ED) Gilbert Castro and explained the purpose of the visit.

On 09/18/2025, LPA L. Alexander requested residents' file documents related to Complaint #15-AS-20240520111558 for Resident 1 (R1) and Resident 2 (R2) from Staff 1 (S1). Staff 2 (S2) subsequently responded to LPA’s request and asked for an extension until 09/23/2025 to provide the requested documents.

During visit, LPA obtained copies of R1's MC Assessment & Service Plan (dated 05/21/24) and Service Plan Reports (dated 09/12/21, 03/11/22, 09/15/22, 03/15/23 and 08/07/23). In addition, LPA obtained copies of R2's Order Summary Report for medication (dated 05/25/23) and Service Plan (dated 02/05/23).

S1 stated that records for year 2024 was not available for R1 and R2. S1 stated that their Health Services Regional will request access to Point Click Care (PCC) liaison through the former software in order to obtain documents.

The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in civil penalties.

Exit interview conducted. A copy of this report and appeal rights provided