Facility Evaluation Report

On 08/22/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted a Case Management visit at this facility. LPA met with designated administrator Evangeline Agatep who allowed for the entry in this facility. LPA informed Agatep the purpose of the visit is to conduct a health and safety check.

LPA reviewed resident's service records and identified Resident #1 (R1) who is under hospice care is unable to self-care requires night supervision. (R1's) Physician's Report LIC 602-A indicated (R1) requires continuous bed care as (R1) is bladder and bowel impairment with dementia.

According to Personnel Report LIC 500 night supervision is on-call basis. There is no regular staff assigned to night supervision shift after 11:00 pm.

Based on observations, interviews, and record reviews, the preponderance of evidence standard has been met with California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099-D.

Exit interview was conducted with Evangeline Agatap, and a hard copy of the report along with appeal rights.