Facility Evaluation Report

Licensing Program Analyst, Cynthia Chan, arrived on December 18, 2025, for an unannounced inspection to follow-up on a case management visit regarding incident report by the facility dated June 18, 2019.

On March 20, 2023, the Department concluded a case management visit regarding the incident involving the death of a client.

The licensee was cited for California Code of Regulations (CCR) § 82078(a) Responsibility for Providing Care and Supervision and CCR 82075(f) Health-Related Services.

At the time of the case management visit on March 20, 2023, an immediate civil penalty of $500 was issued and the licensee was informed that an additional civil penalty might be assessed based on Health and Safety Code §1548(e)(2)(A).

The Department has concluded an analysis and has determined that a civil penalty is warranted for a violation that the Department determines resulted in the death of a client. This is evidenced by the facility’s lack of care and supervision that resulted in the death of the client.

Today, December 18, 2025, the Department will be issuing a civil penalty per Health and Safety Code § 1548(e)(2)(A) for a violation that the Department determined caused the death of a client in the amount of $7,500. However, since an immediate civil penalty of $500 was previously issued on March 20, 2023, the amount of the civil penalty issued today will be $7,000.

Exit interview conducted. A copy of the report issued. Appeal rights provided to Serena Wood and signature on this report acknowledges receipt of the appeal rights, found on page two of LIC 421D.