Facility Evaluation Report

On 8/30/2024 at 03:10pm, Licensing Program Analyst (LPA) L. Hall arrived unannounced to conduct a Case Management visit. LPA met with Wilfredo Bacani, Caregiver.

While LPA L. Hall was conducting a complaint investigation 15-AS-20240826114945 on 8/30/2024, LPA observed the following during visit:

Residents do not have mattress pads, top sheets, and some do not have bedspreads. LPA observed two (2) clean face towels, no hand towels, and three (3) bath towels.

LPA observed unlocked kitchen drawer containing knives.

LPA observed S3 file was not available for review.

Facility will be assessed at $250.00 civil penalty for a repeat violation for 87705(f)(1).

Deficiencies are 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. A copy of the appeal rights and this report provided.