Facility Evaluation Report

On 10/21/2025, Licensing Program Analyst (LPA) Janette Romero made an unannounced visit to the facility to conduct a health and safety visit. Staff Anbra and Renee Oliver were informed of the purpose of the visit. Licensee Jacquelyn White was contacted over the phone and also informed of the purpose of the visit.

LPA toured the facility with Staff Anbra and observed the facility has food and operating utilities. During the visit LPA was informed Resident 1 (R1) passed away in the facility on 10/04/2025 and hospice was notified and responded immediately. However, there is no record the facility reported R1's passing to Community Care Licensing (CCL). As a result, a deficiency will be issued. During the tour, LPA did not observe any additional residents residing in the facility and staff and licensee were advised to notify CCL when a new resident is admitted. Licensee was advised to ensure that all individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) obtain a criminal record clearance or exemption prior to working, residing or volunteering in the facility as required by the Department.

During today's visit no imminent health or safety concerns were observed. An exit interview was conducted and a copy of this report was reviewed with Licensee White along with the Confidential Names list (LIC 811), LIC 809-D, and Appeal Rights, which were all provided to Staff Anbra. A copy of California Code of Regulations, Title 22, Division 6, Chapter 8, regulation 87211 Reporting Requirements were also provided to Staff Anbra for licensee's review.