Facility Evaluation Report

At approximately 1:15 PM Licensing Program Analyst (LPA) Magdaleno arrived unannounced to conduct a Case Management - Annual Continuation for a required 1-year annual inspection started on 10/28/2025 and met with Licensee Maria Del Pilar De Olave. Facility is a Residential Care Facility for the Elderly (RCFE) with three (3) residents in care. Facility has a Dementia Care Plan, a Hospice waiver for two (2), with one (1) Hospice resident currently in care, and is approved for four (4) non-ambulatory residents.

At approximately 1:40 PM LPA conducted a review of three (3) resident records. All required documentation present. At approximately 2:00 PM LPA conducted review of three (3) staff records. All required documentation present. At approximately 2:30 PM LPA and Administrator conducted a spot check of medication and medication records. Medication is centrally stored and locked. Facility does not have a currently certified Administrator ( deficiency cited ). Licensee was provided with resources on renewing their Administrator certificate or hiring a new Administrator.

LPA gathered updated copies of the following documents during this visit: Liability Insurance, LIC500 - Personnel Report, LIC308 - Designation of Responsibility, LIC610E - Emergency Disaster Plan

Deficiencies are cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, or repeat violations within a 12-month period, may result in a civil penalty assessment. Appeal rights were provided. See LIC809D.

Exit interview conducted with Licensee, whose signature on form confirms receipt.