Facility Evaluation Report

On 2/21/26 Licensing Program Analyst (LPA) M. Garza arrived at the facility for an unannounced case management visit. LPA met with Maria Agatep and Elmer Agatep, explained reason for visit and was permitted entry into the facility. Administrator, Soccorro Telmo was contacted and arrived some time later. LPA completed a tour of the facility was completed inside and out. A health and safety check was completed on residents in care.

This case management visit is being completed to address issues observed during a complaint (#24-AS-20260218162333) visit on todays date.

During review of records LPA observed the facility did not have a complete resident file for R1. File was missing documentation (Identification and Emergency Information (LIC 601), Pre-Placement Appraisal (LIC 603), updated Needs and Services Plan (LIC 625) , Release of Client/Resident Medical Information (LIC 605A), valid Admission Agreement. This poses a potential health safety and or personal rights risk to residents in care. Deficiencies issues per California Code of Regulations, Title 22. Deficiencies cited on attached 809D.

Exit interview completed with Administrator, Socorro "Ann". A plan of correction was developed by Administrator and reviewed by LPA. A copy of this report, deficiencies and appeal rights provided.