Facility Evaluation Report

LPAs K.Kaur and L. Salazar questioned Administrator regarding incident report dated 11/1/2024 regarding Resident 1 (R1). Cross Report received from Day Program indicated change in condition for resident was reported to "House Manager" (Patricia) S1. Review of Facility Personnel Report Summary did not have House Manager S1 listed. Administrator provided LPAs proof of finger print clearance for S1, however, review of Guardian and Licensing Information System shows S1 is not associated to the facility.

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

Division 6 and an immediate civil penalty is being assessed in the amount of $500.

An exit interview was conducted with Administrator Alicia Maria Ortiz. Report signed on-site by Administrator, whose signature on the form confirms receipt of this document.