Facility Evaluation Report

This unannounced Case Management – Deficiencies inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of issuing citations for deficiencies observed during the investigation into Complaint Control No. 18-AS-20210824163321. LPA met with Administrator (AD) Gabriela Ciric and explained the reason for today’s inspection.

During the course of the investigation, LPA inspected the facility, interviewed AD and witnesses, and obtained and reviewed copies of the client roster, staff roster, and Client #1’s Physician’s Report dated September 14, 2021.

Per AD, C1 was admitted to the facility on August 13, 2021. However, C1’s Physician’s Report dated September 14, 2021, indicates that C1 did not have a Physician’s Report completed until about a month after admission.

Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. See LIC809D. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.