Senior Care Records.

Facility Evaluation Report

Country Place Assisted Living, Antioch11/08/2023Licence 075601547

Capacity49
Census42
Date signed11/08/2023 02:49:22 PM
The inspector’s account

On 11/08/23 at 2:30PM, Licensing Program Analyst (LPA) D Panlilio arrived unannounced to conduct a case management visit pertaining to an incident which occurred on 10/31/23 wherein 41 residents were left unsupervised during a fire alarm at 4AM set off by a resident. Fire responders confirmed with LPA that they observed no staff was present inside the facility when they deactivated the fire alarm at 5AM on 10/31/23.

An immediate civil penalty of $500 is being assessed for absence of supervision on 10/31/23 which is in violation of Title 22 Section 87415 (a)(2) Night Supervision.

Exit interview conducted, Appeal rights and copy of report provided.

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