Facility Evaluation Report

Licensing Program Analyst (LPA) Cassie Yang arrived unannounced at the facility to conduct a Plan of Correction visit regarding a deficiency cited on November 13, 2025. LPA met with staff and explained the purpose of the visit.

During LPA's annual inspection conducted on November 13, 2025, file review of documents revealed R1 was bedridden but was residing in a non-ambulatory room. Facility is licensed for six non-ambulatory residents.

Facility was cited the following Type A deficiency:

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal.

Plan of Correction was Licensee is to submit LIC 200 and updated facility sketch to LPA for a new fire inspection. The following is due November 14, 2025.

As of today's visit, LIC 200 and facility sketch to request for one bedridden clearance has not been received. Today's visit, a failure to correct civil penalty was assessed. Civil penalty will continue to accrue until plan of correction is received.

Exit interview and copy of the report and appeals rights provided.