Facility Evaluation Report

Licensing Program Analyst (LPA) Leizl de la Cerra conducted an unannounced case management visit to this facility to address the noted deficiencies. LPA had originally arrived to conduct a required annual continuation visit. LPA met with Alicia Avila.

Based on the information obtained from the incident report that occurred at the above facility, it was concluded that LPA's review of the incident which occurred on 9/12/2024 that,

-Facility failed to submit the SIR, LIC624 for occurrence dates of 10/14/22 and 3/12/24 regarding R1's aggressive behavior towards residents.

-The facility staff intervened with R1's personal rights on 9/12/24.

All noted deficiencies were discussed with the Administrator.

Under Title 22 Division 6; Chapter 8 following citations were issued and recorded on LIC809D.

Exit interview was conducted. Copy of report was provided to the administrator.