Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Lyman made an unannounced Plan of Correction (POC) visit to the facility for the purpose of following up on citations issued on LIC form 809D dated 07/03/2026. LPA was greeted and granted entry into the facility and explained the reason for the visit.

*Deficiency cited under Title 22 Regulation 81087(c) pertaining to Buildings and Grounds has NOT been cleared. Exit door is still blocked by a desk in a client room during today's visit. Licensee has NOT complied with the terms of the POC. CIVIL PENALTY ASSESSED.

*Deficiency cited under Title 22 Regulation 81087(a) pertaining to Buildings and Grounds has been cleared. During today's visit, smoke detectors are operational and noted items have been repaired/ replaced. Licensee has complied with the terms of the POC.

Licensee has been advised to maintain all items especially those that were previously deficient in the facility in accordance with Title 22 Regulations.

Copy of this report was provided to the facility.