Facility Evaluation Report

On 10/03/24, Licensing Program Analyst (LPA) M. Yang arrived to conduct an unannounced initial complaint investigation and met with Administrator Maryann Hagstrom.

During the course of the investigation, there were two incident that had occurred on 08/26/24 and on 09/27/24, where C1 was left unattended by staff. The facility did not report written incident for the two incidents to the department.

A deficiency is being cited on the attached Lic 809D in accordance to California Code of Regulations, Title 22, Division 6. An immediate civil penalty is not being cited as the allegation was substantiated in complaint # 24-AS-20240930100339 and a deficiency was cited in that complaint.

Exit interview conducted. A copy of this report and appeal rights was provided to Administrator, whose signature confirms receipt of this report.