Facility Evaluation Report

On this day, Licensee Najeh Hamed and Licensing Program Analysts (LPA) Anna Bueno met at the San Bernardino Regional Office. The purpose of today's meeting is to deliver findings on complaint number 56-AS-20221104151616.

During the investigation of the above mentioned complaint the following violations were discovered. Refer to LIC809-D for deficiency cited.

87208(c) Resident records revealed one resident has a diagnosis of Dementia. This facility has not submitted to a Dementia care plan to the Department and therefore is not authorized to provide care and supervision to residents with Dementia.

87204(b) The facility license identifies first floor bedroom as the only non-ambulatoy bedroom. During the investigation, Resident 1 was occupying bedroom #5 in the second floor.

87506(b) Nine resident records were reviewed and all had missing documents such as, LIC 602 Physician's report, admission agreement, Pre-admission appraisal and/or re-appraisal.

An exit interview was conducted with and a copy of this report, LIC809-D, and appeal rights