Facility Evaluation Report

Licensing Program Analysts (LPAs) Huma Rahimi and Angela Panushkina conducted an unannounced visit to the facility in conjunction with complaint control numbers 31-AS-20251205102316 and 31-AS-20251203143852. LPAs met with Staff #2 (S2), who granted access to the facility. The Administrator was contacted, and LPAs explained the purpose of the visit.

During the visit, LPAs conducted a tour of the facility and observed the following items unlocked and accessible to residents in care:

One Lysol disinfectant spray in Resident #2's (R2) room;

One pair of scissors in a countertop stand;

One container of Lysol disinfectant wipes in the staff room;

One Lysol disinfectant spray in Resident #3's (R3) room; and

Laundry detergents stored in the facility garage.

Additionally, LPAs conducted a review of Resident #2's (R2) records and observed a Physician's Report dated 04/06/2026 indicating that R2 was bedridden. The facility is not approved or fire-cleared to retain bedridden residents.

Based on observations and record review, deficiencies were cited pursuant to the California Code of Regulations, Title 22, Division 6, Chapter 8. The deficiencies are documented on the LIC 809-D.

An exit interview was conducted. Appeal rights were discussed. Copy this report signed and delivered.