Facility Evaluation Report

Licensing Program Analyst, David Roman (LPA D. Roman) conducted an unannounced case management visit to check on the health and safety of residents in care. LPA D. Roman gained access to the facility, identified himself, and met with Facility Manager Assistant, Marianne Alfaro to discuss the purpose of today's visit.

Along with facility staff LPA conducted a tour of the interior and exterior of the facility. LPA obtained additional information about the incident. LPA reviewed the resident (R1) records, interviewed staff and residents. On 05/26/26 a UIR report identified (R1) resident was out of the facility while they became injured and sent to Paradise Valley EMS for recovery. Interview with staff revealed they were unaware that R1 was not able to leave the facility unassisted. Upon R1 record review, the LIC602 Physician's Report, identified on page 5 of 9 in the Capacity for Self Care, section h. Able to Leave Facility Unsupervised (considering physical or cognitive abilities); if no explain. The "No" check box is marked, Explain: "best to have someone w/her due to vulnerability."

Based on the records reviewed during the case management visit the Department determined that the incident is a violation which resulted in the injury or illness of a person in care. An immediate civil penalty is being assessed in the amount of $500.00 and is noted on the LIC 421IM. Per Health and Safety Code Section 1569.49, an additional civil penalty is under review by the Program Administrator of the Community Care Licensing Division.

An exit interview was conducted with Facility Manager Assistant, Marianne Alfaro to which a copy of this report along with Licensee/Appeal Rights was provided to them whose signature below confirms the receipt of this report and their rights.