Senior Care Records.

Facility Evaluation Report

Simone Summit Care Home, Brentwood10/30/2025Licence 079201139

Capacity6
Census1
Date signed10/30/2025 04:10:15 PM
Name of licensing program analystTonica Syess-Gibson
Name of licensing program managerHarpreet Humpal
The inspector’s account

On 10/30/2025, while LPA T. Syess-Gibson was conducting a complaint investigation 15-AS-20250905154824 on 10/15/2025. During interview and record review LPA observed R1’s file was missing documents. LPA requested Home Health (HH) plan of care for R1. Administrator stated that she has to contact the HH agency for care plan, does not have a plan of care at the facility. LPA requested the HH plan of care and care notes be emailed by 11/06/2025.

The deficiencies were observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiencies may result in 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