Facility Evaluation Report

Licensing Program Analyst (LPA) Rebecca Ruiz conducted a complaint investigation visit where an unrelated deficiency was discovered. LPA was greeted by, identified herself to, and explained the purpose of the visit to Caregiver Clarinda Griffith. Licensee Teresita "Roxie" Roxas arrived during the visit.

During today's visit, LPA conducted a tour of the facility, reviewed and obtained copies of facility records, and interviewed staff. Review of Resident 1's (R1) physician's report revealed that resident is bedridden, unable to reposition independently and is receiving hospice services. Interviews with staff and hospice staff confirmed the bedridden determination. Review of the facility's license revealed that the facility is only licensed for 1 bedridden resident to be housed in a room with a direct exit to the outside. Per California Code of Regulations Title 22, the following deficiency is cited on the attached LIC809-D page. A civil penalty in the amount of $500 has been assessed during the visit.

An exit interview was conducted with Licensee 'Roxie' Roxas, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 01/16).