Senior Care Records.

Facility Evaluation Report

Kaiser Specialized Residential Perignon, Apple Valley01/19/2024Licence 366424489

Capacity4
Census4
Date signed01/19/2024 11:52:32 AM
The inspector’s account

Licensing Program Analyst (LPA) Javier Prieto made an unannounced visit to the facility to conduct a Health and Safety case management visit. This case management visit is in response to an adult death of resident #1 (R1). LPA Prieto met with Administrator Jordan and explained the purpose of the visit.

During today’s visit, LPA Prieto conducted a facility tour and an interview. LPA Prieto advises MS Jordan that this may require an additional visit to obtain documentation.

No deficiencies were cited during this visit. An exit interview was conducted with MS Jordan and a copy of this report was left with facility.

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