Facility Evaluation Report

Licensing Program Analyst (LPA) Rayshaun Nickolas conducted a case management deficiency visit. The case management visit is in response to a deficiency cited at the facility. LPA met with Licensee Victor Mercado and explained the purpose of the visit.

During a facility file review, LPA discovered that the facility had not reported any unusual incident or injury to Community Care Licensing Division (CCLD) since November 2020. LPA also observed a bedroom window covered with window film installation and card board. LPA interview with the Licensee revealed that the window is broken. The Licensee also stated that they are in the process of getting the window repaired. However, the Licensee was unable to prove that they are in the process of repairing the window.

Based on observations made during today, two (2) deficiencies was cited per Title 22, Division 6, of the California Code of Regulations (CCR), Sections 87211 Reporting Requirements and Section

An exit interview was conducted and a copy of this report, LIC 809D, and Appeal Rights were provided.