Facility Evaluation Report

Licensing Program Analyst's (LPA's) Amy Rodgers and Amy Domingo conducted an unannounced Health and Safety Checks visit regarding a deficiency that was cited on 8/4/26. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit Xitlali Esquivel, Med Tech. The Executive Director, Amber Rodgers and RSD Eva Zuluaga also participated in the meeting.

On 8/4/26 the facility was issued a deficiency for accepting and/or retaining bedridden residents without having a fire clearance that allows so. A Plan Of Correction (POC) was developed on 8/4/26 between Community Care Licensing (CCL) and the facility, with a due date of 8/5/26.During today's visit, LPA's conducted a health and safety check with bedridden residents, [See LIC 811 Confidential Name List for a description of select person identifiers used in this report], as identified during the visit conducted 8/4/26.

While touring the facility Staff 1 (S1) stated that they do not have keys to open the resident rooms. A deficiency will be given for the facility not providing a safe environment for the residents. A deficiency will be given for staff absent from their scheduled shift. A deficiency will be given regarding coverage by a designated substitute. A deficiency will be given for staff not following physician's medication order.

For today's visit deficiencies were issued per Title 22 Division 6 of the California Code of Regulations. See LIC809-D dated for 8/8/26. A plan of correction was jointly developed with the Executive Director. An exit interview was conducted with Amber Rodgers, Executive Director to whom a copy of this report, the LIC 811, the POC, the LIC 421FC, and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.