Facility Evaluation Report

Licensing Program Analyst (LPA) Ruth Martinez is conducting this case management visit for the purpose of a health and safety check. Shaleemar Balignasay, Administrator met with LPA.

LPA observed all window of the facility had the shades closed. LPA was granted access to the facility and LPA was able to enter the facility. LPA took a tour of the physical plant of the facility. LPA observed the facility to be empty and there was no indication that there were any residents. LPA observed the facility still had running water but no power. LPA did not observed any food supplies. As of today's date the facility remains empty with no residents in care and no indications that the house is used to provide care to residents. LPA observed the facility to have minimal furnishings and resident bedrooms to be empty. Caregiver was unsure if the facility will be occupied or renovated for now, but that is unclear for now if and when that will happen. LPA at the time of visit did not observe any health and safety concerns in or out of the facility. Licensee to contact Community Care Licensing (CCL) to inform of when they are ready to accept new residents or if there are any changes with the license. As noted Licensee will contact CCLD once residents are being admitted. In an effort to update the facility file, the Administrator is required to submit to the licensing agency a copy of the following: An updated Personnel Report (LIC 500) and Copy of Administrator Certificate.

Based on the observations made during today’s visit, no deficiencies are being cited per Title 22, Division 6 of the California Code of Regulations.

This report was reviewed with facility representative and a copy of was provided to the facility.