Facility Evaluation Report

Licensing Program Analyst (LPA) Yolanda Delgado is conducting an unannounced case management visit on this date to check on the health, safety, and welfare of clients in care. LPA learned that three (3) clients reside in the facility. There are one (1) staff on duty currently. There are working utilities and sufficient food supply.

During this visit LPA was accompanied by the Administrator and the new Licensee, LPA observed a blue strap with a latch on the end laying on the floor popping out under a brown recliner chair in the living area, with assistance from staff, the brown chair was flipped over and a blue strap that resembled a seat belt was pulled from the interior of the chair. LPA observed a resident in a bed with full rails. LPA conducted interview with administrator.

Based on the information obtained today, two (2) deficiencies are being issued per Title 22, Division 6, Chapter 8, Article 8, Section 87468.2(a)(8) and Title 22, Division 6, Chapter 8, Article 11, Section 87608(a)(B) of the California Code of Regulations with Civil Penalties of $600.

This report, LIC809D, LIC421IM and Appeal Rights was reviewed with Favie Jimeno, and copies provided at the time of exit interview.