Facility Evaluation Report
On 10/07/2025 at 10:47AM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 10/05/2025. LPA met with Liezyl Ajos Administrator and explained the purpose of the visit.
Incident report dated 10/05/2025 revealed that R1 went outside of the facility R1 was found by Brentwood Police officer(BPO) who brought R1 back to the facility. BPO did not leave a report number or contact number. Facility notified R1’s responsible party and Licensing.
LPA interviewed staff (S1), obtained and reviewed documents provided which included physician's report, appraisal needs and services, staff schedule and resident’s roster.
The following deficiency were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22 and/or Health and Safety Code. Failure to correct deficiency by POC date and/or any repeat deficiencies within a 12-month period may result in additional Civil Penalties.
Exit interview conducted and a copy of this report and appeal rights provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction