Facility Evaluation Report

On 01/22/2026, Licensing Program Analyst (LPA) Janette Romero conducted an unannounced case management visit to the facility to follow up on an incident report submitted by Administrator Jenny Castellanos reporting an incident that occurred in the facility on 01/18/2026 involving Resident 1 (R1), Resident 2 (R2), and Staff 1 (S1). LPA was greeted and granted entry by Activity Director (AD) Fely Dizon who was informed of the purpose of the visit. Administrator Castellanos was phoned and also informed of the purpose of LPA's visit and arrived to the facility to meet with LPA.

The incident report documents on 01/18/2026, R1 observed S1 slap R2 on the left side of their head during lunchtime. The incident report documents S1 was immediately terminated and Administrator Castellanos reported the incident to R2's responsible person, Community Care Licensing, the Long-Term Care Ombudsman and law enforcement. Administrator Castellanos reported R2 was assessed and denied having any pain/injuries as a result of the incident.

During today's visit, LPA toured the facility with AD Dizon, conducted interviews, and

obtained copies of pertinent records. During the visit, LPA did not observe any immediate health or safety concerns nor did LPA observe S1 to be present in the facility. No deficiencies were cited during today's visit. An exit interview was conducted and a copy of this report was reviewed and provided to Administrator Castellanos.