Facility Evaluation Report

12/8/25, Licensing Program Analyst (LPA) J. Leffall conducted a case management and follow up on documentation written in Resident (R2) Admission Agreement.

During the Investigation of a complaint received by the Department on 9/23/25, the assigned LPA to the Investigator from the Investigative Bureau assigned to the complaint read documentation from a different Resident not connected with the complaint. It was discovered that sections of R2's Admission Agreement were written by facility that violated R2's Personal Rights. The facility had both R2 and R2's family sign the Admission Agreement.

A citation is being issued on the attached 809-D in accordance with California Code of Regulations, Title 22,Division 6.

A copy of this report with Appeal Rights was issued to Administrator whose signature confirms receipt of this report.