Facility Evaluation Report
On 08/12/2025, Licensing Program Analyst (LPA) Regina Cloyd conducted an unannounced Plan of Correction (POC) visit as a follow up to the annual inspection on 08/07/2025. LPA met with Staff and Administrator Antonia Dionisio. The facility is licensed for six residents and approved for two hospice residents. Bedroom #1 is approved for ambulatory only. Bedrooms 2, 3, and 4 are approved for non-ambulatory residents.
On 08/07/2025, during the facility tour, LPA observed Resident #4 (R4) in bedroom #5. The fire department inspection does not reference a bedroom #5 and the facility sketch on file with Community Care Licensing Division does not reflect a bedroom #5. On 08/11/2025, Administrator indicated that R4 would be moved once she spoke with the family and bedroom #5 would be transitioned into a storage room.
On 08/12/2025, LPA observed R4 in bedroom #5. Administrator indicated that Hospice will assist the resident to transition into bedroom #4 on 08/13/2025 between 1:00 PM - 3:00 PM. Continue to LIC809-C.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction