Senior Care Records.

Facility Evaluation Report

Mih-5 Care Home, INC, Stockton02/06/2024Licence 392701073

Capacity4
Census3
Date signed02/06/2024 11:55:55 AM
The inspector’s account

Licensing Program Analysts (LPA) Kesha Lewis arrived at the facility unannounced for the purpose of conducting a case management incident inspection regarding two incident reports received dated 02/01/2024 . LPA explained purpose of visit to the administrator.

The incident report was regarding a resident death and resident breaking the window and the facility bedroom door. LPA reviewed incidents reports and facility provided R1'S IPP, care notes and physician's report (602). LPA also interview administrator. All incidents were reported on time and to the correct departments. Death report not available at this time.

Per California Code of Regulations, Title 22 no deficiencies were observed or cited during today's case management inspection.

An exit interview was conducted and a copy of this report was given.

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