Facility Evaluation Report

On 06/04/26, Licensing Program Analyst (LPA) Kimberly Viarella made an case management visit to this facility to follow-up on deficiencies observed during the complaint investigation # 27-AS-20260602154338 that was conducted earlier today.

* LPA observed that R1 had an outdated LIC 602. Regulations require annual updates or whenever a change of condition has been observed. medical professional. This deficiency has been cited on the LIC 809D page.

* LPA learned through an interview with the House Manager that R1's mental state had changed since they were first admitted. Licensee did not provide appropriate assistance to R1 when they noted change in R1's mental state or deterioration of mental ability and did not ensure that these changes were documented and brought to the attention of the resident's physician and the resident's responsible person, if any. This deficiency was cited on the LIC 809D page.

* LPA observed that staff training did not contain all of the required topics and documentation did not include all of the required components. These deficiencies have been cited on the LIC 809D page.

* LPA observed that R1 did not have a signed admission agreement for the facility in which they currently reside. This deficiency has been cited on the LIC 809D page.

* LPA observed that staff health records did not include the name of staff person assessed. LPA provided technical assistance.

According to the California Code of Regulations, Title 22, no other deficiencies were cited during today's visit. A copy of this report was provided along with APPEAL RIGHTS and an exit interview was conducted with Nawasa.