Facility Evaluation Report
Capacity6
Census1
Date signed01/12/2022 01:22:19 PM
Licensing Program Analyst (LPA) Elizabeth Irra completed this Case Management-Deficiencies report during (2) complaint investigations. File review revealed that R-1 independently moved into this facility and resided at this facility from 12/28/2021 through 01/03/2022. During this visit, LPA observed R-1 did not have a Physician's Report on file. Per Administrator, R-1 was in the process of obtaining a Physical exam.
Deficiency cited under California Code of Regulations Title 22. Refer to LIC 809D.
Exit interview conducted, a copy of this report and Appeals Rights provided to S-1/Facility Administrator.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction