Facility Evaluation Report

On 2/11/22 at 2:45 PM, Licensing Program Analysts (LPAs) Jill Clancy-Czuleger and Lizette Francisco arrived unannounced to conduct a Case Management to follow-up on an incident report submitted to CCL on 1/21/2022. LPAs met with Executive Director and explained the purpose of the visit.

Based on incident report, facility had a COVID-19 outbreak on 1/05/2022. However, incident report was not submitted to licensing until 1/21/2022. On 1/27/2022 and 2/8/2022, LPA J. Clancy-Czuleger was notified of new positive cases. However, facility did not report to LPA within 24 hours of occurrence via phone call.

The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct deficiencies by POC date may result in additional Civil Penalties.

Exit interview conducted. Appeal rights and a copy of this reporat provided.