Senior Care Records.

Facility Evaluation Report

California Mentor - 256th Home, Lomita05/10/2023Licence 198601604

Capacity4
Census3
Date signed05/10/2023 01:43:41 PM
The inspector’s account

ON 05/10/23 LICENSING PROGRAM ANALYST(LPA) Antonine Richard conducted a Case Management visit regarding the passing of a Resident #1. LPA met with staff Xiomara Vanegas, and the purpose of the visit was explained.

LPA reviewed CCL's Regional Office records and observed that the facility is a four (4) bedrooms two (2) bathrooms, a living area a dining area and kitchen.

On the 5/10/23, LPA interviewed Staff surrounding Resident #1 death. LPA collected a copy of the Resident' records.

Based on documentation and interviews conducted, there is no deficiency cited

An Exit interview was conducted. A copy this report was given to Xiomara Vanegas

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