Facility Evaluation Report

On 01/14/26 Licensing Program Analyst (LPA), M. Garza arrived at the facility to complete an unannounced annual visit. LPA met with Program Director, Pamela Chin, explained reason for visit and was permitted entry into the facility. LPA completed a tour of the facility inside and out. A health and safety check was completed on clients in care. There were 4 clients present during todays visit.

Pathways and doors were clear and free from obstruction. Facility was without odor. Common areas were adequately furnished, and adequately lit. Smoke detectors and carbon monoxide detectors present and operational at time of visit. Fire extinguisher last serviced 11/21/25. Last fire drill on conducted on 12/19/25. Sharps and chemicals were located in locked cabinets/closets and cupboards.

The following issues were observed during today’s visit: 1 of 2 files reviewed did not have a health screening and 2 of 2 did not have documentation of a criminal record clearance or exemption. 1 of 2 client files reviewed disclosed client has a restricted health condition and does not have a Needs and Services Plan or Restricted Health Condition Care Plan in place prior to admission. Disaster drills are not being conducted every six months. Facility does not have a current, written and mass casualty plan of action. Deficiencies cited per California Code of Regulations, Title 22. Deficiencies are being cited on the attached 809D. If not corrected, the violation with have a direct risk to the health, safety and/or personal rights of residents in care. TSP was offered and declined.

LPA requested the following documents to be submitted to CCL by 1/23/26: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-D), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020) in order to update the facility file.

Exit interview was conducted with Program Director, Pamela. A plan of correction was developed by Administrator and reviewed by LPA. A copy of this report, deficiencies, and appeal rights were discussed and provided to Administrator.