Facility Evaluation Report

On 09/09/25 at 1PM, LPA D Panlilio conducted an unannounced case management visit and met with licensee/administrator (ADM). LPA explained the purpose of the visit with ADM.

At 1:20PM, LPA observed no resident living at the facility. Licensee/ADM stated that they only had one female resident (R1) on hospice who passed away peacefully in her sleep on 05/09/25. LPA observed all signages (Complaint poster, COVID signs, Personal rights, Emergency/Disaster plans, Ombudsman poster) have been removed.

ADM stated they have decided to close the RCFE facility since they want tot convert the home as a rental property. ADM surrendered the facility's State License to LPA during visit.

LPA advised ADM that the facility closure request will be processed at CCLD RO Oakland on 09/12/25.

No deficiencies cited during visit. Exit interview conducted and a copy of the report provided.