Facility Evaluation Report

While at the facility investigating two complaints (Control #'s 15-AS-20230626085047 and 15-AS-20230626143338), Licensing Program Analyst (LPA) Delmundo observed the following while conducting inspection with Ferdinand Gutierrez, administrator:

1. Front entrance door and 2 of the residents' rooms do not have auditory signals. The exit doors in the kitchen and family room's auditory signals broken. Resident (R1) was able to AWOL unnoticed by the staff.

2. Strong smell of urine. The administrator stated that resident (R2) who has dementia and incontinent is refusing care.

3. Used mattress, big piece of rolled carpet in the front yard, and pieces carpet in the side yard.

4. Grass cutter, shovel and rake in unlocked storage in the side yard.

Deficiencies are cited from Title 22 California Code of Regulations and listed on 809Ds. Failure to submit proof of correction by plan of correction due dates, and any repeat violation within 12 month period may result in additional civil penalties.

Deficiencies plan and proof of correction were discussed with administrator.

Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.