Facility Evaluation Report

At 1:45 pm, Licensing Program Analyst Sandra Urena conducted an unannounced Plan of Correction visit. The LPA spoke with Administrator Emma Avetisyan and explained the reason for the visit.

At 2:15 pm, the LPA conducted a complete a file review (see LIC 858) for the four residents residing at the facility. Upon review of residents' files, it was observed that three out of four residents’ files are missing a TB test date, and results were lacking evidence of a TB exam, or date of exam or type of test.

Therefore, based on records reviewed the following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties.

Exit interview conducted. Signatures obtained. A copy of the report and appeal rights were provided.