Facility Evaluation Report, 09/15/2022 — Mih-5 Care Home, INC, Stockton CA

Facility Evaluation Report

Mih-5 Care Home, INC, Stockton09/15/2022Licence 392701073

Capacity4

Census4

Date signed09/15/2022 04:23:44 PM

The inspector’s account

Licensing Program Analysts Albert Johnson and Kesha Lewis arrived to conduct an unannounced Case Management visit. LPAs met with Whitney M.

Community Care Licensing received incident reports on 08/14/2022 regarding a an AWOL. LPA requested residents files for review. LPA spoke with Administrator regarding the incident reports.

LPA did obtained copies of resident records. R1 is allowed to go into the community without assistance. This is identified in R1's IPP. R1 is allowed to go into the community without assistance.

Per California Code of Regulations and Health and Safety Code, Title 22.

Exit interview. Copy of report provided to facility representative.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction