Facility Evaluation Report

On 10/09/2025, Licensing Program Analyst (LPA) Yi Sam Jian conducted an unannounced case management visit to follow up on an incident report that was submitted to CCLD on 09/25/2025. LPA met with Assistant Health Care Director, Derrick Nguyen, and Community Director, Sam Faye, arrived later during the visit. LPA explained the purpose of the visit.

The facility submitted a written incident report indicating that on 09/25/2025, at approximately 10:37 AM, Resident R1 pushed resident R2, causing R2 to fall backwards onto floor.

During the visit, LPA interviewed staff and collected documentation.

Report is reviewed with the Community Director, and a copy is provided