Senior Care Records.

Facility Evaluation Report

Mih-5 Care Home, INC, Stockton10/29/2024Licence 392701073

Capacity4
Census4
Date signed10/29/2024 02:08:04 PM
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 an allegation against a staff member on 10/23/2024. LPA explained purpose of visit to the administrator.

The incident report was regarding allegation against a staff member. LPA reviewed incidents report and facility provided R1'S IPP, physician's report (602), police report number, emergency contact, staff schedule for months May, June and July, and staff roster with contact information. During first visit. LPA also interview administrator. all were provided via email on 10/25/2024. All incidents were reported on time and to the correct departments. LPA also interviewed administrator LPA also spoke with licensee.

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