Facility Evaluation Report
Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Case Management Deficiencies in conjunction with a complaint visit (Complaint Control # 28-AS-20250522124740 ) . During the visit, LPA reviewed files for Resident #1 (R1) and observed that the facility did not submit an incident report for R1 who fell on 04/25/2025 and sustained an injury. The Administrator, Jacqueline Cortez searched through the files and confirmed that the facility failed to submit the incident report (SIR) and will be faxing the incident report to CCL today.
Deficiency is noted on LIC 809D. Exit interview, a copy of this report and Appeals Rights were provided to
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction