Facility Evaluation Report

On 04/23/2025 at 12:35PM, Licensing Program Analysts (LPAs), T. Syess-Gibson and L. Hall arrived unannounced to conduct a health and safety check. LPAs met with Sakaraia Kata, Direct Care Staff, Direct Care Staff, Caregiver and explained the reason for the visit.

Upon arrival at 10:00AM, LPAs initially arrived to conduct a 10-day complaint visit for 15-AS-20250421120751 and observed four (4) residents watching television, and the other residents were residing in their bedrooms.

During the health and safety check, LPAs toured the facility including but not limited to common areas, bathrooms, bedrooms and outdoor common area. The facility is noted to be clean, in good repair, and residents in care appear to be safe. There is a minimum of 7-day non-perishables and 2-day perishables foods. There are no imminent health/safety concerns on today's date.

During visit LPAs observed the following deficiency:

At 10:50am, LPAs observed during record review resident (R5) did not have a home health care plan.

Deficiency cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (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 and a copy of this report and appeal right provided .