Facility Evaluation Report

On 11/06/25, Licensing Program Analyst (LPA) V Gorban conducted an unannounced case management-deficiency visit. LPA met with executive director Shawniee Jackson.

This case management visit is being conducted based on findings during complaint investigation that incident report on multiple occasions was not reported to Licensing office: R1 emergency visit due to fall and missed medications on tow different occasions.

Another deficiency observed staff records for S1 is incomplete. Based on During interviews reported that R1 fell on February 23 and was taken to emergency department due to injury.

Both deficiencies are being cited on the attached 809D in accordance to California Code of Regulations, Title 22,

Division 6.An exit interview was conducted. A copy of this report and appeal rights was provided to L1, whose signature on this form confirms receipt of this report.