Facility Evaluation Report

Licensing Program Analyst (LPA) Katie Brown conducted a case management-incident visit in conjunction with the facility Annual Inspection LPA met with and explained the purpose of the visit with Administrator (AD) Dwayne Smith.

The facility submitted Special Incident Reports (SIR) dated 1/9/23 and 1/18/23 reporting that Resident (R1) was experiencing a behavioral emergency resulting in hospitalization. During the visit, LPA toured the facility conducted interviews and a record review of R1's file.

During the facility tour, LPA observed that the blinds, windowsills, doors and walls throughout the facility need to be cleaned. A deficiency is being cited in accordance with California Code of Regulations on the attached LIC 9099-D.

An exit interview was conducted and Plan of Correction was developed. A copy of this report and Appeal Rights were discussed and left with Dwayne Smith, whose signature on this form confirms receipt of these documents.