Facility Evaluation Report

Licensing Program Analyst (LPA) Claudia Gutierrez conducted an unannounced Case Management inspection in conjunction with investigation into complaint number 22-AS-20250528163140. LPA met with Staff Dave Sombilon and explained the purpose of the inspection.

During the course of the investigation, deficiencies were observed. During their interview, Licensee Representative (LR) Janice Jabonero stated that the original agreed upon basic service fee for Resident 1 (R1) was $4,500, however, the amount had originally been left blank at the time that the admission agreement was signed.

Per California Code of Regulations Title 22, 87507(g)(3)(A) The licensee shall complete an individual written admission agreement and include payment provisions, including rate for all basic services which the facility is required to provide in order to obtain and maintain a license.

Based on observations made during this inspection, one deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was left at the facility.