Facility Evaluation Report

This unannounced Case Management – Deficiencies inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of issuing citations for deficiencies observed during the investigation into Complaint Control No. 22-AS-20250924155802. LPA met with Administrator (AD) Brisseth Arrellano and explained the reason for today’s inspection.

During the course of the investigation, LPA inspected the facility, conducted health and safety checks on residents, interviewed AD, residents, and staff, and obtained and reviewed copies of the resident roster, staff roster, and Resident #1’s (R1) Medical Records.

Per AD, R1 was sent to the hospital on September 5, 2025, due to change in condition and is still hospitalized, but this incident was not reported. Based on incident reports received at the Orange County Regional Office (OCRO) and AD’s admission, R1’s hospitalization on September 5, 2025, was not reported as required.

Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. Civil penalties for repeat violations are being assessed. See LIC421FC. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.