Facility Evaluation Report

Licensing Program Analyst (LPA) Albert Marin made an unannounced visit to this facility to conduct a case management visit. LPA was granted entry after completing the Coronavirus 2019 (COVID 19) screening procedures. Via phone, LPA spoke to Administrator Sherry Dizon and stated the purpose of the visit. Shortly after, Administrators (AD) Emmanuel Dizon and Sherry Dizon arrived in the facility.

On September 16, 2021, Community Care Licensing Division (CCLD) Orange Office received an incident report from the facility stating that Resident 1 got out of the facility without assistance.

For this visit, LPA Marin toured the interior and exterior portions of the facility. LPA observed two residents in care and two staff members on the floor. LPA tested auditory exit alarms and all were observed to be operational. LPA also observed motion sensors scattered in common exits of the facility. LPA reviewed facility files. Per file review of Resident 1's physician report issued last August 7, 2021, Resident 1 has primary diagnosis of Dementia, and indicated not able to leave the facility unassisted.

For this visit, deficiency was observed and citation was issued per Title 22 Division 6 of the California Code of Regulations.

LPA Marin conducted an exit interview with AD E. Dizon. LPA discussed the deficiency, citation and appeal rights. LPA left copies of this report, Deficiency (809-D), appeal rights, and copy of cited regulations in the facility.