Facility Evaluation Report

On 8/6/25 at 10:00am, Licensing Program Analyst (LPA) Noel Wolf Petersen arrived unannounced to conduct a case management related to updating paperwork at the facility. The LPA met with the backup administrator Lakbir "Lucky" Kaur and explained the purpose of the visit. They have 3 current residents, who are don't have restricted conditions and are ambulatory, who plan on transfering to the new property in Stocton when that Change of Location happens. This Location will be reapplied for as a RCFE.

A Physical plant inspection was conducted including but not limited to the common areas, kitchen, storage areas, exterior, evacuation routes resident bathrooms and resident bedrooms. The facility is clean and the traffic areas are unobstructed. Resident bedrooms have all the required funishings and furniture.

the smoke alarm is functional. LPA mentioned the required posters for resident rights, facility sketch with evacuation routes, and ombudsman contact poster were not on the walls, the administrator made immedate remedies for the missing posters. The fire extinguisher is dated 1/29/25. the first aid kit has the required items.

2 of 3 client records were reviewed, MARs were current to date and reflected in avalible medication. 2 of 7 staff were intervewed, and 2 of 7staff records were reviewed for trainings, first aid certification and crm bkrnd.

LPA asked for some docuements to be emailed in connection with the visit by 8/13/25: liability insurance, LIC 9020, sample admission agreement(with ammendums as necessary), current Lease agreement.

No citations were issued as part of this visit. a copy of the report was read and given to the staff after an exit interview.