Facility Evaluation Report
Capacity35
Census30
Date signed06/16/2022 03:45:52 PM
On 06/16/22 at 3:30PM, while at the facility for another reason, Licensing Program Analyst (LPA) D Panlilio discussed that there was no unusual incident report (LIC 624) submitted on 06/03/22 to CCLD reporting there were 4 COVID positive residents on that day.
Deficiency is cited per Title 22 California Code of Regulations and listed on LIC9099D.
Failure to submit proof of correction (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties .
Exit interview conducted. Appeal Rights and a copy of this report provided via email.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction