Facility Evaluation Report

On 11/22/20222 at 10:25AM, Licensing Program Analysts (LPAs), L. Hall and L. Holmes arrived unannounced to conduct a health and safety check as a result of the department receiving a complaint. LPAs met with Chioma "Abigail" Okpara, Administrator and explained the reason for the visit.

Upon arrival, LPAs observed total of two (2) staff and one two (2) residents in the facility. LPAs was informed that one (1) resident was in the hospital and one (1) resident has been transferred to a skilled nursing and is not returning.

During the health and safety check, LPAs toured the building with Administrator including but not limited to common areas, bathrooms, and bedrooms. Facility is noted to be clean and in good repair and residents in care appear to be safe. There are no imminent health/safety concerns on today's date.

LPAs observed the following deficiencies:

- Resident files for R1, R2, R3, and R4 were incomplete.

- Administrator did not submit an incident report for R1 and R2

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, LIC9098, and appeal rights provided