Facility Evaluation Report

Licensing Program Analyst (LPA) Jose Villalobos conducted subsequent unannounced Required- 1 year visit using the full Care Compliance and Regulatory Enforcement (CARE) Tools. The purpose of the visit was explained to Staff Kim Mims. The following (3) of (12) CARE tool domains were completed during the inspection:

Sufficient space to accommodate both indoor and outdoor activities was observed.

Emergency and Disaster Plan LIC 610E is in place.

There are currently (6) residents on Hospice and (25) on Home Health

Individual Service Plans and Appraisals are on file.

No residents have prohibited health conditions.

Auditory signals for emergency exits observed and operational

No bodies of water observed and fireplace is blocked and inaccessible to residents

All (12) domains have been completed as of todays visit. Per California Code of Regulations, Title 22, Deficiencies are being cited. Please see LIC 809-D page

Exit interview was conducted and a copy of this report and appeal rights were provided and discussed.