Facility Evaluation Report
Capacity6
Census6
Date signed04/12/2023 12:23:20 PM
On 04/12/2023, during an unannounced complaint inspection, Licensing Program Analyst (LPA) J. Sampair observed a bed railing on resident R1's bed without a physician's order and Caregiver Evangeline Polito who was not associated with the facility for which a civil penalty was issued.
Deficiencies cited per Title 22 California Code of Regulations is listed on the LIC9099-D. Failure to submit proof of correction (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. Appeal Rights and a copy of this report provided via email.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction