Facility Evaluation Report

On 09/17/24, Licensing Program Analyst (LPAs) Gina Saucedo and Angelica Segovia conducted unannounced, initial visit to this facility in conjunction with a complaint control #31-AS-20240911090516 LPA met with the Caregiver, Farrah Siddiqui and explained the reason for the visit.

During the physical tour, LPA conducted a review of records and no incident report-Unusual Incident/Injury Report was sent to Community Care Licensing Department-(CCLD) for any of the residents that have recently gone to a hospital and incidents in the house that involved police activity.

Furthermore, there has been changes to the original facility sketch. There was a removal of a garage that was originally in the facility sketch. It is now converted to a three (3) unit living area and has a white gate surrounded the area. The original facility sketch had a clearance for a garage. In addition, there is an individual living in one (1) of the three (3) living areas that is not background cleared.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are cited and noted on LIC 809D.

Exit interview conducted, appeal rights and copy of report signed and delivered to the Assistant Administrator.