Facility Evaluation Report

Licensing Program Analyst (LPA) Michael Hood met with Executive Director (ED), Kimberly Hagen, to conduct a case management visit.

During inspection conducted on 3/24/2023, it was discovered that a written notice regarding change in level of care regarding private duty personnel was not issued to resident (R1) within 2 days after the implementation of new services due to a change of level of care. LPA requested the 2 day written notice for the private duty personnel implemented during today's visit and facility was unable to supply requested document.

Per Health and Safety Code § 1569.657 (a), a deficiency is being cited on the attached 809-D.

Exit interview was conducted with ED. A copy of this report and appeal rights were provided. The ED’s signature on these forms acknowledges receipt of these documents.