Senior Care Records.

Facility Evaluation Report

Kaiser Specialized Residential Perignon, Apple Valley03/04/2024Licence 366424489

Capacity4
Census4
Date signed03/04/2024 02:10:04 PM
The inspector’s account

Licensing Program Analyst (LPA) Michelle Echeverria conducted an unannounced visit to this facility to initiate an investigation of complaint number: 56-AS-20240227092232. LPA met with staff, Melinda Corbin.

During today's visit, LPA conducted a health and safety check and reviewed facility records. LPA found the following issues:

Insufficient supply of 2 days of perishables and 7 days of nonperishables.

A client admitted to the facility without the approval of the licensing agency for a protective device to be used.

These pose an immediate and potential health and safety risk to residents in care. Refer to LIC 809D for deficiencies cited.

An exit interview was conducted where this report, LIC809D, and appeal rights were discussed with and provided to the administrator, Lawanna Jones who later arrived.

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