Facility Evaluation Report
Capacity6
Census6
Date signed01/22/2025 11:39:42 AM
Licensing Program Analyst (LPA) Kesha Lewis arrived unannounced to open a complaint and during the visit learned of another indent. resulting in this a case management.
LPA Lewis came learned that R4 had fallen and been sent to the hospital on 01/19/2025. LPA Lewis contacted the department to try and verify that the indent had been reported but no report could be found. LPA Lewis interviewed residents and and staff that confirmed this had occurred. see 812's from complaint visit.
Deficiencies cited see 809D page per California Code Regulation, TITLE 22.
Exit interview was conducted and a copy of the report and appeal rights given.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction