Facility Evaluation Report

This Licensing Program Analyst (LPA) M. Flores arrived unannounced to continue an annual inspection. LPA was allowed entry by Administrator, Constance Peters.

LPA completed record reviews for staff and resident files.

Deficiency are being cited in accordance with the California Code of Regulations, Title 22, see LIC809D.

The following updated forms are to be submitted to CCL by 02/27/24: LIC308, LIC 309, LIC 400, LIC 402, LIC 500, LIC 610D, LIC 9282, LIC999, and control of property.

An exit interview was conducted, and a Plan of Correction was reviewed and developed with the Administrator. A copy of this report and appeal rights were discussed Administrator, Constance Peters whose signature on this form confirms receipt of these documents.