Facility Evaluation Report

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced case management visit to cite a deficiency identified during a complaint investigation that is unrelated to the complaint allegations. LPA identified herself to, was greeted by, and explained the purpose of the visit to Administrator Teresita "Roxie" Roxas.

During the unrelated complaint investigation, it was determined that Resident 1 (R1) experienced a medical emergency and was sent to the hospital for treatment on 4/26/2025 and 5/3/2025. Interviews with the Administrator and review of documents received by the Department from the facility revealed that incident reports had not been submitted for either of those incidents. Therefore, a deficiency regarding reporting requirements is being cited per California Code of Regulations Title 22 and noted on the attached LIC809-D page.

An exit interview was conducted with Administrator Teresita "Roxie" Roxas, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 3/22).