Facility Evaluation Report

Licensing Program Analyst (LPA) Mary Rico and Licensing Program Analyst Manager (LPM) Efren Malagon met with Licensee Kristine A. Mangente at Community Care Licensing Division (CCLD) Adult and Senior Care (ASC) Regional Office to provide a case management report pertaining to complaint 56-AS-20250114090200.

On 1/15/2025, during visit, LPA Rico requested R1 file for review. For the following documents: Physician Report, Admission Agreement, Preplacement Appraisal and Hospice Care Plan. S1 stated the only document available for R1 was the Admission Agreement, which was observed to be incomplete. Prior to R1 move-in, the following documents should’ve been completed and kept for a minimum of three years.

Furthermore, LPA request a copy of R1 Death Report. S1 stated that they did not have copy and did not submit a death report to Community Care Licensing. LPA verity R1 Death Report was not submitted to Community Care Licensing database.

A total of six (6) deficiencies was cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted where this report, LIC809, LIC809D, were discussed and provided to Licensee Kristine A. Mangente. Along with a copy of appeal rights.