Facility Evaluation Report

At 10:30am, Licensing Program Analyst (LPA) Angela Panushkina conducted unannounced visit to this facility in conjunction with a complaint, control #31-AS-20260505111640 . LPA met with the Administrator and explained the reason for the visit.

S1 present during the incident that occurred on 05/03/2026 was not fingerprint cleared/associated with the facility

During the visit, LPA also conducted review of all incident reports on a system and did not observe an Incident Report submitted to the Community Care Licensing Department (CCLD) in a timely manner. In addition, the Administrator admitted that no incident was submitted to the Regional Office (RO). Based on Title 22 Regulation: a written Unusual Incident / Injury Report shall be submitted to CCLD within seven (7) days of occurrence. LPAs informed the Administrator that all staff members are mandated reporters, and they are all responsible for reporting.

LPA informed the Administrator to submit an incident report that occurred on:

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are cited and noted on LIC 809D.