Facility Evaluation Report

Licensing Program Analysts (LPAs)Elena Mallett and Bonnie Tao conducted an unannounced Case Management visit to the facility to check PNI accounts of residents in care. The LPA was met by Caregiver Staff 1(S1) and the purpose of the visit was discussed.House Manager Peter Ventura was contacted by phone shortly after beginning of visit, The facility is licensed to serve 4 Non-Ambulatory Residents ages 60 and above, with a hospice waiver for (1) one. 2 residents were present in the facility today and 2 were at Day Program.

The facility is a single-story home located in a residential area in Norwalk, CA. LPA toured the common areas and observed no health and safety risks.

LPA asked and obtained current resident and staff rosters along with resident PNI ledgers for 4 clients in care. LPAs observed PNI ledgers for Residents (R) 1-4 not be up to date. Per phone conversation with House Manager Peter Ventura the PNI Ledgers for all residents were not current and not reconciled.

Upon review of the PNI ledgers LPA found that resident accounts were not being accurately recorded each month. A deficiency was observed. ( See LIC 809-D)

Per Title 22 Regulations deficiencies were cited today. An exit interview was conducted with Staff 1 and explained to House Manager Ventura over the phone. A copy of this Licensing Report and a copy of Appeal Rights was provided.