Facility Evaluation Report

Licensing Program Analyst (LPA) Jey Cardenas completed a case management visit to the above facility; during a site visit regarding a complaint investigation control number 11-AS-20220225084441 . During this visit LPA observed deficiencies that is non-related to the complaint investigation conducted on 2/25/2021. The following was discussed with the Administrator, and direct care staff;

LPA observed facility walls throughout the facility have dirt and dust .

LPA observed smoke detector in the hallway is missing, one smoke detector in room1 is hanging by the wires, and LPA heard chirping coming from smoke detector.

LPA observed blinds throughout the facility are broken, slates are missing/ broken. LPA observed Room#1 drawers are missing, one drawer is hanging and doesnt not slide open easily.

LPA observed food items are taken out of original packaging and not labeled- Fruit Loops are taken out of the original box, and transfered to a plastic storage container which is not labeled.

Per California Code of Regulations, Title 22 the following deficiencies were observed and cited: (Refer to LIC 809-D)

Exit interview conducted, appeal rights issued, and a copy of the report was provided.