Facility Evaluation Report

Licensing Program Analyst (LPA) K. Kaur and Shawna Doucette arrived at the facility to conduct a complaint investigation. During the course of the investigation other deficiencies were observed.

LPAs observed via video Resident (R1) attempting to climb over a recliner that was propped in front of the bottom half of the resident's hospital bed after the top half railing ended.

Deficiencies are being cited on the attached 809D in accordance with California Code of Regulations, Title 22, Division 6.

Exit interview conducted and a plan of correction was reviewed and developed with Administrator. A copy of this report and appeal rights were discussed and provided to Administrator, whose signature on this form confirms receipt of this document.