Facility Evaluation Report

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management Visit to cite a deficiency identified during a separate complaint investigation. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Christopher Diaz. LPA also spoke via phone with Licensee Dr. Mohammed Rahan during the visit.

Interviews of facility staff showed that that when residents were short on personal supplies in the past, staff sometimes took supplies belonging to one resident to use/share for another resident, instead of alerting the appropriate responsible persons (RP) and/or facility management. The supplies in question were paid for by those residents or their RPs, and not by the Licensee. Interviews identified at least two affected residents, Resident #2 (R2) and Resident #5 (R5).

One (1) deficiency was cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D page). A Plan of Correction was jointly developed with the Licensee.

An exit interview was conducted with Dr. Rahman, to whom a copy of this report, the LIC 809-D, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.