Facility Evaluation Report

Licensing Program Analyst (LPA) Tao and Licensing Program Manager (LPM) Fierros conducted an unannounced Case Management- Health and safety check visit at the facility. The facility was licensed to serve the elderly who are 60 years and older and had 25 hospice wavier approved. Its capacity was 200 residents including 149 non-ambulatory, of which 15 may be bedridden. LPA and LPM met with Gil Agas, administrator and Justin Lee, administrator assistant. The purpose of today's visit was explained to them.

On today’s visit, LPA and LPM conducted a physical plant, reviewed/obtained 15 residents’ files. Licensing conducted the physical plant with Gil and Justin and toured all three floors at the premises. During the physical plant, all 50 carbon monoxide devices at the facility were not working.

LPA obtained copies of the following documents:

LPA and LPM did not observe nor identify signs of neglect, abuse or other immediate health and safety threats.

Deficiencies were observed and cited in LIC 809 D during this visit. Exit interview was held with administrator. This report LIC 809 and appeal rights were provided to administrator.