Facility Evaluation Report

Licensing Program Analysts (LPAs) Rebecca Borunda and Jose De La Cruz conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPAs were greeted by, identified themselves to, and explained the purpose of the visit with Debbie Dala, Guest Services Manager.

During today's visit, LPAs toured the facility, reviewed facility records, and observed residents in care. Review of the facility’s fire clearance dated 8/1/2002 and review of the facility’s licensed capacity revealed that the facility is approved for a maximum capacity of 200 residents, 75 of which might be non-ambulatory. Interviews with staff revealed that a majority of residents required the use of an assistive device such as a walker or wheelchair and estimated that approximately 85 residents required the use of a walker or wheelchair.

Due to time constraints, the annual inspection could not be completed and a return visit on a subsequent day is needed. LPAs were away from the facility for approximately thirty minutes between 1:30 pm and 2:00 pm.

The following deficiency for over capacity of non-ambulatory residents is cited per California Title 22 and noted on the attached LIC809-D page. Additionally, a civil penalty in the amount of $500 was assessed for over-capacity and noted on the attached LIC421IM form.

An exit interview was conducted with Debbie Dala Guest Services Manager, MJ Bachelor, Health and Wellness Director, whose signature below confirms receipt of a copy of this report LIC421IM and the Licensee Appeal Rights (LIC9058 3/22).