Facility Evaluation Report

On July 28, 2026, Licensing Program Analysts (LPAs) Brandon Lopez and Tran Nguyen made an unannounced visit to the facility to conduct a Case Management - Deficiencies visit. Resident Services Director Mirian Im was present and assisted on today's visit.

This visit is being conducted in conjunction with complaint control number 22-AS-20240417153456. Per California Code of Regulations, Title 22 Section 87211(a)(1)(d) states the following: "(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident."

During the complaint investigation, the Department discovered that Resident #1 (R1) sustained a total of nineteen falls between the dates of May 4, 2023, to May 4, 2024. The Department observed that R1 was hospitalized as a result of three of the falls. The Department also discovered that Resident #2 (R2) sustained a total of twenty five falls between the dates of June 21, 2023, to April 30, 2024. The Department observed that R2 was hospitalized as a result of two of the falls. The Department observed that the facility only reported two out of the nineteen falls that R1 sustained to Community Care Licensing, and therefore, seventeen falls were not reported as required by regulations. The Department observed that the facility only reported four of the twenty five falls for that R2 sustained to Community Care Licensing, and therefore twenty one falls were not reported as required by regulations. CONTINUED ON LIC809-C