Facility Evaluation Report

Licensing Program Analyst (LPA) Claudia Gutierrez conducted an unannounced Case Management inspection in conjunction with investigation into complaint number 22-AS-20220831133413. LPA met with Tristan Raquipo and explained the purpose of the inspection.

During the course of the investigation, deficiencies were observed. Upon request of Resident 1’s (R1’s) file, facility was unable to provide any documentation pertaining to R1. During interviews, Staff 1 (S1) stated R1 was at the facility from 8/17/22-8/26/22 and R1’s responsible party had taken all documentation upon discharge on 8/26/22.

Per California Code of Regulations Title 22, 87506(a) The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff; additionally per 87506( e) Original records or photographic reproductions shall be retained for a minimum of three (3) years following termination of service to the resident.

Based on observations made during this inspection, two deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report and appeal rights was left at the facility.