Facility Evaluation Report

On 05/07/2025 at 1:30pm Licensing Program Analysts (LPAs) L. Alexander and Y. Brown arrived unannounced to conduct a Case Management visit. LPAs met with Administrator, Jeffrey Tong.

While LPAs L. Alexander and Y. Brown was conducting a complaint investigation (15-AS-20250430190433 ) on 05/07/2025. During tour of the facility, LPAs observed that Resident (R) R1's space to get to the bathroom was limited. LPAs brought this issue to S1 and S1 rearranged the room to accommodate better space so that R1 can move around to bathroom if needed.

LPA's observed that there was oxygen in use in R2's room but there was no "Oxygen in Use" signage posted. LPA's observed at 11:54am in shared bedroom for R2 and R3 there was a bottle of Equate ClearLax laxative unlocked.

LPA's observed during file review at 12:05pm that R1's admission agreement was signed 12 days after they were admitted and R1's file was incomplete and missing 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