Facility Evaluation Report

On 10/06/25, Licensing Program Analyst (LPA) M. Yang arrived to conduct case management visit and met with Administrator/ Licensee Leticia Jackson.

During the course of the investigation for complaint on 09/09/25, interviews were conducted, records were reviewed, and facility was toured. During tour of the facility, the garage refrigerator was observed not cleaned with food grime. On 09/09/25 visit, LPA was informed R1 was at the hospital. R1 and R2 are receiving hospice care. R2 was observed with full rail bed.

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

Division 6. An exit interview was conducted. A copy of this report was provided to Administrator, whose

signature on this form confirms receipt of this report.