Facility Evaluation Report

Licensing Program Analyst(LPA) Christine Yee conducted an unannounced case management visit due to deficiencies noted during a visit to the facility today. The reason for today's visit was provided.

During today's visit LPA Yee received information that the facility receives Resident #1's Social Security Income and State Supplemental Payment in the facility's bank account. A copy of the Surety Bond was requested and could not be provided. A request was made by the facility administrator to the facility's insurance agent to obtain coverage today and will not be available for a couple of days. Evidence that a Surety Bond with the appropriate limits will be provided to Licensing as soon as it becomes available.

Deficiency cited under California Code of Regulations, Title 22, Division 6, Chapter 8.

Exit interview was conducted, Appeals Rights discussed and a copy was provided.