Senior Care Records.

Facility Evaluation Report

Caroline Street, Adelanto10/16/2023Licence 361880596

Capacity4
Census3
Date signed10/16/2023 12:25:38 PM
The inspector’s account

Licensing Program Analyst (LPA) Rayshaun Nickolas conducted a case management deficiency visit. LPA met with house manager Shazet Knowles at an off site location.

On October 16, 2023, LPA Nickolas' conducted a facility tour in response to complaint control number 56-AS-20231009161458. During the facility tour, LPA Nickolas' discovered that resident #2 (R2) is unable to close their bedroom door because of damage to the door, that was caused by resident #1 (R1). LPA Nickolas observed that the door handle was turned down, and the door was broken around the deadbolt, preventing the door from shutting closed.

Based on observation and interview one (1) deficiency was cited per Title 22, Division 6, of the California Code of Regulations (CCR).

An exit interview was conducted with Knowles and a copy of this report, LIC 809D, and appeal rights were provided.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction