Facility Evaluation Report

Licensing Program Analyst (LPA) Victoria Brown arrived unannounced on a subsequent closure visit on 12/28/2023 at 3:30p. LPA met with Jovita Aduca, Caregiver and stated the purpose of the visit.

During the closure visit LPA requested to review 2 resident files which were incomplete.

In addition, the caregiver attempted to call the Licensee/Administrator regarding the visit and at this time 4:36pm the caregiver(s) have not received a call back.

Based on file reviews and observation these deficiencies will be cited during this visit.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, the following deficiencies are being cited on the attached 809D during this visit.

If any of the cited deficiencies are not corrected by the noted due dates; civil penalties may be assessed.

The facility representative was provided a copy of their rights (LIC9058) and their signature on this form acknowledges receipt of these rights.

An exit interview was conducted, a copy of the report was given.