Senior Care Records.

Facility Evaluation Report

Ageway Boarding Care #3, Union City10/10/2022Licence 015601493

Capacity6
Census5
Date signed10/10/2022 01:35:01 PM
The inspector’s account

On this day 10/10/22, Licensing Program Analyst (LPA) C. Lin conducted a case management visit and met with Administrator. LPA explained to him purpose of the visit.

During an investigation conducted by the Department, records obtained indicate that R1's pre-appraisal (LIC603) was not completed when admitting to facility on 3/1/2022. Administrator admitted it, agreed to have it complete, and keep it on file.

A deficiency was observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to submit proofs of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties .

Exit interview conducted with Administrator. A copy of this report and Appeal Rights was provided.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction