Facility Evaluation Report

On 07/11/2024, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual continuation visit. LPA met with Facility Designated Administrator (FDA), Priya Lal and explained the purpose of the visit.

The purpose of this visit was to continue an annual visit conducted on 04/25/2024 and 05/09/2024.

Current census was 109. A brief interview with FDA Lal was conducted.

During the course of this visit, LPA toured the facility and reviewed facility resident records.

LPA reviewed 8 resident files during this visit. LPA reviewed a total of 14 resident files throughout the annual visit. Based on record review, it was found that 6 out 14 resident files do not have a pre-appraisal assessment on file. Based on interviews conducted with facility staff it was learned that the facility has been directed to use the company's personal service assessment and discontinue the pre-appraisal form. However, this LPA reviewed the Personal service assessment form and found that it does not capture assessment for the following areas: Medication, Service needs, Ambulatory status, TB test conducted, and social factors.

The following forms and documents were requested to be updated and submitted into CCL.

A technical violation is being provided for the following sections 87705(c)(5) and 87457(c).

Per California Code of Regulations (CCR) – Title 22 – Division 6, Chapter 6, deficiencies were observed during today’s visit. Citations can be found on the LIC 809 – D. Failure to correct deficiencies may result in civil penalties. Appeal Rights and a copy of this report were provided to the facility.