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Facility Evaluation Report

Annika Grace Care Home, Lancaster06/27/2023Licence 197610178

Capacity6
Census2
Date signed06/27/2023 04:31:55 PM
The inspector’s account

On 06/27/2023 in conjunction with an initial complaint visit control number 31-AS-20230619091039, Licensing Program Analyst (LPA) Evelin Rios completed an unannounced CASE MANAGEMENT- Deficiencies visit. LPA met with Administrator Jozam Latayan Batulan, explained the purpose of the visit.

At 12:15 p.m. LPA reviewed two (2) out of two (2) resident records. Review revealed resident #1(R1) and resident#2 (R2) records are incomplete by missing the following: Identification and emergency information, pre- admission appraisal, needs and services and functional capabilities. Administrator confirmed they did not complete documentation missing in residents' records.

Per the California Code of Regulations (CCR), Title 22, Division 6, Chapter 8, the following deficiency was observed and cited (Refer to LIC 809-D).

Copy of this report provided, appeal rights given. Exit interview conducted.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction