Facility Evaluation Report

On today's date 06/07/24 Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to follow up on an Unusual/Injury report and SOC341 that was received reporting sexual abuse regarding Resident #1 (R1). LPA met with Administrator Benito Encabo and explained the purpose of the visit.

LPA conducted a tour of the facility, there were no health and safety concerns observed. The facility had operable utilities, and an adequate food supply. LPA conducted a review of staff and resident files. R1s file review revealed that the department was not notified of R1s death. LPA conducted an interview with Administrator Benito Encabo and verified the dates of the incident (6/6/22) which revealed that the incident was not reported to the department. A deficiency will be cited on the attached 809 for failure to follow reporting requirements.

In addition LPA conducted a facility file review which revealed that the facility has unpaid annual fees of $742.00, that was due on or before 12/17/23. a deficiency will be cited on the attached 809. During the visit LPA provided Administrator with the PIN to pay the fees electronically.

Based on today's case management incident visit a citation will be issued in accordance with the California Code of Regulations (Title 22, Division 6, Chapter 8).

An exit interview was conducted and a copy of this report, LIC 811-Confidential names list, LIC9098-Proof of Corrections form and appeal rights were provided to Benito Encabo, Administrator.