Facility Evaluation Report

At approximately 8:15AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility unannounced to conduct a Required-1 Year inspection. LPA met with Administrator Zenia Shah and explained the purpose of the visit. This inspection is a continuation of the 04/22/2025 visit to review staff and resident records.

At approximately 9:15AM, LPA reviewed 7 of 42 resident files. All resident files contained the required documentation. Reappraisals were conducted within the last 12 months. Documentation of physician visits within the last 12 months or a signed declination were present.

At approximately 11:00AM, LPA reviewed 5 staff files. Staff files reviewed did not contain evidence of completed annual training. First Aid/CPR certification was current.

At approximately 11:45AM, LPA conducted a review of medications. Medication is locked and not accessible.

Updated copies of the following documents were requested for facility file and are to be submitted to CCL within 30 days of this visit:

LIC308- Designation of Facility Responsibility

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

This report was reviewed with Zenia Shah and Appeal rights were given.