Facility Evaluation Report
On 11/05/2025, Licensing Program Analysts (LPAs) K. Nguyen and P. Manalo arrived unannounced to conduct a case management visit. LPAs met with Direct Care Staff, Teresita Collong, and explained the purpose of the visit.
While LPAs were at the facility for another visit, LPAs record review revealed that the following documents including but not limited to LIC627C (Consent Form), LIC9158 (Telecommunications Device Notification), LIC601 (Identification and Information), and LIC621 (Resident Personal Property and Valuables) was not signed and/or completed. Record review also revealed that R1 does not have a full bed rail on file.
The Facility was cited from the California Code of Regulations, Title 22 and/or Health and Safety Code Failure to correct deficiencies by POC date may result in additional Civil Penalties.
Exit interview was conducted and Appeal Rights was provided to Collong.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction