Facility Evaluation Report
Capacity106
Census73
Date signed12/27/2022 02:31:01 PM
Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit for the purpose of conducting a Case Management visit regarding the Unusual Incident Report (LIC 624) sent to the regional office December 6, 2022. LPA spoke with Staff 1 (S1) and Staff 2 (S2) regarding the incident.
Regarding the incident report dated 11.28.22, LPA Haley received a copy of Resident 1's (R1) physicians report, and signed move out form. R1 made the decision to move out of the facility December 20, 2022.
No deficiencies are being cited as a result of today's visit. An exit interview was conducted and a copy of this report was provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction