Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit in conjunction with complaint visit 22-AS-20250804142753. LPA was greeted and granted entry into the facility and explained the reason for the visit.

Upon entry, LPA was greeted at the door by Resident 1 (R1) with no staff around. Caregiver was attending to other residents. R1 went into the kitchen and was going through cupboards and LPA observed there are no protective mechanisms on two of the burners (photos). Per physician report dated 02/27/2025, R1 is diagnosed with Dementia.

Licensee to forward an updated LIC 500 to LPA by 08/08/2025.

Based on the observations made during today’s visit, deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided as well as appeal rights.