Facility Evaluation Report
Capacity6
Census4
Date signed10/01/2021 03:53:31 PM
On 10/1/2021, during the course of another visit, Licensing Program Analyst ( LPA ) L. Ibo and Regional Center of East Bay QA Synthia Hakola conducted a joint case management visit, LPA observed that R1 has bruises on her left side of her face and wearing a cast and arm sling.
LPA conducted interview with staff and resident, and requested for the following documents; LIC602a , special incident report (SIR) , and LIC500.
LPA interviewed resident (see lic812 fore detailed information)
Exit interview conducted, copy of this report provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction