Facility Evaluation Report

On 03/19/25, Licensing Program Analyst (LPA) M. Yang arrived to conduct a case management-deficiency

visit. LPA met with Licensee/Administrator (L1) Lina Juarez and staff(S1) Shervin Mohammadi.

During the annual inspection on 03/18/25, LPA reviewed residents record and conducted interviews. L1 and S1 stated R1 had went to the hospital on 02/13/25 and 02/25/25 and was not reported to the department Records were reviewed and confirmed resident to the hospital.

Deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22,

An exit interview was conducted. A copy of this report and appeal rights was provided to Licensee, whose

signature confirms receipt of this report.