Facility Evaluation Report
Capacity6
Census5
Date signed05/23/2022 05:13:09 PM
On 5/23/2022, Licensing Program Analyst (LPA) L.I bo conducted unannounced case management visit. On 5/13/2022 LPA found out that facility had 1 case of covid19 on 5/4/2022, Licensee Brian Friedel stated and confirmed that case was not reported to CCL office. On 5/13/2022 incident report was sent to LPA L.Ibo via email.
· Administrator failed to follow CCLD reporting requirements.
The deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations. Failure to correct deficiencies by POC date may result in additional Civil Penalties.
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