Facility Evaluation Report

Licensing Program Analyst (LPA) Tena Herrera conducted a Case Management Visit-Deficiencies stemming from Annual Inspection dated 8/28/25, LPA met with Administrator Brandie Mendibles and Assistant Administrator Jason Perez, the purpose for todays visit was explained.

Per additional information gathered on Appeal that the department received on 9/15/2025 for a deficiency cited during Annual Inspection and LPA’s observations, the Department determined the following citations were to be issued based on the Annual visit dated 8/28/25 and are listed in detail on the following page.

The following citations will be issued during todays visit:

Section 87465(h)(3) - Facility failed to have a separate container with the required information on the label for residents #3 and #5.

Section 87465(a)(4) - Facility failed to obtain a D/C order and centrally store Resident #1’s PRN medications

Section 87465(h)(6)(A-E) - Facility failed to list Resident #3’s routine medication on the eMAR

Exit interview was conducted. A copy of this report, deficiencies and appeals rights were provided.