Facility Evaluation Report

This case management visit is conducted by the Licensing Program Analyst (LPA) Leslie Ngo-Castaneda in conjunction with complaint investigation visit to address the issues related to the complaint # 31-AS-20260213125854. On 2.23.2026 while LPA was conducting complaint investigation, LPA discovered the following:

Staff #1 (S1) is the appointed designee when facility administrator is not available. Record review revealed S1 does not have LIC 308 form.

It was also revealed that S2 sleeps at the facility and that S2 would work off the clock during grave yard shift when residents needed help.

Resident #3 (R3) sustained scratched on their face and facility did not report incident to RO.

Resident #1 (R1) does not have Appraisal Needs and Service Plan (LIC 625).

Under Title 22 Regulations, the following citation is issued and recorded on LIC809-D.

No immediate health and safety hazard is noted at the time of this visit. Exit interview was conducted. Appeal rights discussed and a copy of report was issued.