Facility Evaluation Report
On 05/23/25 Licensing Program Analyst (LPA) Leslie Ngo-Castaneda, conducted an unannounced case management visit. LPA met with the licensee and disclosed the reason for the visit.
This case management visit was conducted in conjunction with complaint investigation #31-AS-20250520140015 to address deficiencies related to the complaint. Facility licensee did not submit an death reports or other required reports to the Licensing Division. During the initial complaint investigation, LPA conducted a facility records review and interviews with licensee revealed on 2.27.2025 for resident #1 (R1) death report. LPA asked and spoked with the licensee requesting an email or fax results that was sent to RO, but licensee could not provide the fax result/ email of R1 Death Reports to LPA.
At the time of this visit, the licensee was informed reporting requirements and failed to follow Tittle 22 reporting requirements.
Deficiencies are cited on the corresponding 809-D page.
No immediate health or safety hazards were observed during today's visit. Exit interview conducted.
Appeal rights discussed. Copy of report provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction