Facility Evaluation Report

This unannounced Case Management – Incident inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of a health and safety check and to follow up on an incident reported verbally to LPA by Administrator (AD) Maxine Kniazeff on 10/24/23 regarding Resident #1 (R1). LPA met with Staff #1 (S1) Olivette Crisostomo and discussed the purpose of the inspection. AD appeared via telephone.

During today’s inspection, LPA toured the facility with S1 and observed 1 staff and 2 residents present. LPA conducted health and safety checks on the residents present and observed no health and safety issues. LPA observed the facility to be clean and organized and found no health and safety issues. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food, the electricity and water were running, and the medications and sharps were properly stored. LPA interviewed AD and requested and reviewed copies of the resident roster and staff roster. AD stated they will email LPA copies of the incident report once it is complete as well as R1’s resident file.

There were no health and safety concerns observed in the areas inspected. Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.