Facility Evaluation Report
Capacity6
Census4
Date signed05/07/2025 04:14:57 PM
Name of licensing program analystKelly Nguyen
Name of licensing program managerBennett Fong
On 5/7/2025 while conducting a Case Management Licensing Program Analysts (LPA) K. Nguyen reviewed resident files and interviewed staffs, shows that prior to hospitalization R1 have a wound located on the left side of R1 hip.
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 right provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction