Facility Evaluation Report

Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced Case Management - Deficiencies visit in conjunction with a complaint visit (Complaint control # 29-AS-20230804102833). LPA met with Assistant Administrator Gaiane Egizarian. The purpose of this visit is to issue citations for deficiencies observed during the complaint investigation which were not related to the complaint.

File review prior to visit indicated that room #3 is cleared for Ambulatory residents only. During the complaint visit, LPA conducted physical plant at approximately 9:15am, LPA observed Resident #1(R1) laying in bed in room #3. Resident records review at approximately 10:15am, revealed that R1 is listed as Non-Ambulatory. Assistant Administrator was advised to relocate resident to a room that has approved fire clearance for resident use.

A $500 immediate civil penalty is assessed today. The Assistant Administrator was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(f).

Pursuant to Title 22 CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D):

Exit interview conducted/Citations issued/ Appeal Rights Discussed/ Copy of this report issued.