Facility Evaluation Report

Licensing Program Analyst ( LPA ) Talwinder Bains conducted a case management visit to this facility on 5/6/26.LPA met with Staff, RN, Erica Self and explained the purpose of today's visit.

The purpose of today's visit is to follow up the visit conducted at this facility by the Department of Healthcare Services (DHCS) on 3/24/26. Based on 3/24/26 facility visit, Department of Health Care Services (DHCS) issued facility’s evaluation report which indicated deficiencies issued to facility as a copy facility visit was received by Community Care Licensing Division (CCLD). The visit today is to address the issues found DHCS facility visit from 3/24/26 that apply to Title 22 Regulations.

Based on the DHCS report, the facility violated the following Title 22 violations:

-The admission agreement for three (3) residents (R1, R2, R3) were present but no documentation was available if residents receive a copy of admission agreement as required. **This is a repeat citation within 12 months.

-Record review indicated that for residents, R1 and R3 that the written assessments were not done as required upon admission.

- Record review reflected that the facility was unable to provide documented evidence that the staff preparing the treatment/rehabilitation plans had received training in these areas.

- Record review indicated that the facility was unable to provide documentation evidence that the treatment plan was completed for resident, R2 within 72 hours of admission as required.

Based on the above, deficiencies are cited pursuant to California Code of Regulations, Title 22 and documented on the attached LIC809D.

Exit interview conducted and copy of report, LIC809G and appeal rights provided.