Facility Evaluation Report

Licensing Program Analyst (LPA) Angela Hood arrived at the care home today and met with the Administrator, Maria Williams, to conduct a case management visit in relation to a separate inspection conducted on today’s date, August 13, 2025.

The facility provided LPA an Unusual Incident/Injury Report LIC624 regarding resident (R1) for an incident that occurred on October 8, 2024. The LIC624 received indicated that emergency medical services were not utilized and were not needed. However, interviews, medical records, and home health records indicated that R1 was sent to the emergency room on October 8, 2024. The facility did not submit additional information regarding the emergency room visit to CCL as required. The facility provided LPA with Personnel Records LIC501 for staff (S2, S3, S4, and S5), which were incomplete. The LIC501s had missing personal information for each staff member.

As a result of today's inspection, deficiencies are being cited pursuant to California Code of Regulations, Title 22, Division 6, Chapter 8. Deficiencies are listed on 809-D pages.

Exit interview was conducted. A copy of this report and appeal rights were provided.