Facility Evaluation Report

Licensing Program Analyst (LPA) Ashley Calderon conducted a health and safety check at the above facility in response to a Special Incident Report (SIR) that was submitted to Licensing on 01/26/2023. LPA met with Administrator Swarna Amarsmghe to discuss the purpose of todays visit.

Investigation consisted of the following: LPA Calderon collected residents and staff roster, police report incident #923-01679-1349-144 that occurred on 1/25/23. LPA obtained records of Client #1 (C1) and Client #2 (C2): Client's assessment and history, care coordination plan, physician's report, identification and emergency information, and progress notes.LPA Calderon along side with Swarna toured the physical plant, which consist of a single story buildings: main house, two middle cottages, men's dorms, back unit, a total of twenty-four resident bedrooms, court yard patio, middle patio and backyard. LPA toured all rooms in the main house, cottage 1 and 2, men's dorm, back unit and did not observe any safety concerns. LPA Calderon observed common areas like dinning room/ tv rooms, no concerns observed.

LPA observed the client's in care to identify any signs of neglect, abuse, or other immediate health and safety threats; LPA did not observe any immediate Health and/or Safety concerns. No deficiencies cited under California Code of Regulations Title 22

An exit Interview was conducted with the Administrator Swarna Amarsmghe and provided a copy of todays report.