Facility Evaluation Report

Licensing Program Analyst (LPA) Rebecca Borunda conducted an announced case management visit to cite deficiencies observed during a complaint visit that are unrelated to the complaint allegations. LPA identified herself to, was greeted by, and explained the purpose of the visit to Administrator Irene Palad.

During the unrelated complaint visit, LPA reviewed resident records and determined that Resident 1 (R1) was unable to reposition in bed independently and was bedridden. [Administrator was provided with an LIC811 Confidential Names List to identify R1] Therefore, a deficiency regarding bedridden fire clearance is being cited per California Code of Regulations Title 22 and noted on the attached LIC809-D page. Additionally, a civil penalty in the amount of $500 is being issued on an LIC421IM form.

An exit interview was conducted with Administrator Irene Palad, whose signature below confirms receipt of a copy of this report, LIC811, LIC421IM, and the Licensee Appeal Rights (LIC9058 3/22).