Senior Care Records.

Facility Evaluation Report

Country Place Assisted Living, Antioch10/15/2024Licence 075601547

Capacity49
Census41
Date signed10/15/2024 05:15:36 PM
The inspector’s account

On 10/15/24 at 4:37PM, Licensing Program Analyst (LPA) Carol Fowler arrived unannounced to open a 10 day initial complaint on an unrelated matter and conducted a case management deficiency. LPA met with Yvonne Golden, Lead Med Tech, and explained the purpose of the visit.

During the initial 10 day complaint opening, LPA observed that R1 Physician Report (LIC602) is missing from R1's file. Staff contacted the Administrator via phone call and Administrator stated that R1 doesn't have a current Physician Report.

Regulations are cited from California Code of Regulations, Title 22, are being cited on the attached LIC809D. Therefore, this allegation is Substantiated .

Exit interview conducted. A copy of this report and appeal rights provided.

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