Facility Evaluation Report

Licensing Program Analyst (LPA) Cassandra Mikkelson and Cheyenne Ratajczak arrived to the facility to conduct a case management visit. LPAs met with Licensee and explained the purpose of the visit.

LPAs conducted a file review of five (5) resident files, toured the facility and conducted interviews.

As a result of this visit, deficiencies were cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. Deficiencies are listed on 809-D pages.

Exit interview was conducted with Licensee. A copy of this report and appeal rights were provided. Signatures on these forms acknowledges receipt of these documents.