Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced health and safety visit in conjunction with a Plan of Correction visit. LPA was greeted and granted entry into the facility by Caregiver Gloria Sandoval and explained the reason for the visit.

During the visit, LPA toured the facility and observed the split resident room referenced in complaint #22-AS-20221115083100 and observed two residents are residing in the split room. On 11/21/2022, Licensee was cited for altering the room without a permit and LPA conducted a visit with City of Orange Code Enforcement. Licensee and Administrator participated in a phone call, same day, with LPA Lyman and LPM Alisa Ortiz regarding the resident residing in the room during that visit. Per Code Enforcement, Licensee and Administrator were advised no residents were to be residing in the room until the room was permitted. During today's visit, LPA Lyman spoke with Licensee Shah who stated he had submitted the paperwork to the city and was waiting for response. Licensee stated intent to go down to Code Enforcement to get an update. LPA reiterated no residents were to be residing in the room until permitted. Licensee ended the call.

LPA made multiple attempts to contact Administrator and received no response. Licensee to forward a copy of resident roster to LPA by close of business Friday, December 9, 2022.

Based on the observations made during today's visit, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with Licensee and a copy will be provided as well as appeal rights.