Facility Evaluation Report

On 12/29/2023 at 4:20pm, Licensing Program Analysts (LPAs) L. Hall and T. Syess-Gibson arrived to conduct an case management visit. LPAs met with Edwin Liwanag, Administrator and explained the reason for the visit.

While LPAs L. Hall were conducting a complaint investigation (15-AS-20231219162259 ) on 12/29/2023. During record review LPAs observed that S1 had not reported to CCLD that R2 had been hospitalized and admitted into hospice services.

Deficiency is 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.