Facility Evaluation Report

Licensing Program Analyst (LPA) Quoc Huynh conducted an unannounced Case Management visit in conjunction with Complaint # 29-AS-20260303165713. The LPA arrived at 9:17AM and met with Administrator Carrie Acosta. Entrance interview conducted.

Between 9:20AM and 10:45AM, the LPA conducted a physical plant tour and reviewed resident and staff files. Four (4) out of four (4) residents were receiving hospice services and the facility did not have hospice care plans on file.

Additionally, a review of the facility’s staff roster revealed two (2) staff were not associated to the facility and had prior criminal record clearance. Staff #1 (S1) was hired in March 2023 and Staff #2 (S2) hired on 02/15/2026.

An immediate civil penalty in the amount of $1,000, $100 per day for a maximum of 5 days per staff, was assessed on a violation of criminal record clearance (Refer to LIC 421BG). The Administrator was advised that failure to correct may result in additional civil penalties.

Pursuant to Title 22 CA Code of Regulations and/or the Health and Safety Code, the following deficiencies were cited (Refer to LIC 809-D).

Exit interview conducted. A copy of the appeal rights and report was reviewed and issued.