Facility Evaluation Report
On 12/10/2025 Licensing Program Analysts (LPAs) B. Miranda & S. Doucette arrived at the facility unannounced to conduct a case management visits to issue citations for deficiencies found while investigating complaint #24-AS-20251112135800. LPAs introduced themselves and explained the reason for the visit. LPAs met with Danielle Mouw and explained the reason for the visit.
LPAs reviewed R1's records and observed R1's admission agreement was signed on 10/29/2025, and an incomplete pre-admission appraisal. On 11/4/2025 R1 was taken to the hospital. Staff Danielle Mouw stated the facility was not able to handle R1's behaviors and R1 was being aggressive towards staff. R1 returned to the facility on 11/21/25 and a reappraisal was not completed for R1's change in condition indicating wound care and a puree diet.
On 11/18/2025 LPA verbally requested a printout of resident's call button log and via email on 11/25/2025. No records have been provided until today during an unannounced visit. The delay in providing required documents impedes the process of a complaint.
Exit interview was conducted and a copy of this report LIC809, LIC809D, and appeal rights were provided to Danielle Mouw.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction