Facility Evaluation Report

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management Visit and met with Administrator Marlene Elliot. The purpose of the visit was to check on the resident records of resident R1, who was previously a resident at Elliot Home II. R1 was one of three residents who resided at Elliot Home II. The other two residents now reside at other facilities.

During visit, LPA Marrufo reviewed R1's resident record. LPA Marrufo observed that R1 had the following records current at Elliot Home III: Admission Agreement, Physician's Report, Appraisal/Needs and Services Plan, Emergency Contact and Information Form, LIC613 Personal Rights, Consent for Medical Treatment, Record of Client's/Resident's Safeguarded Cash Resources, and Centrally Stored Medication and Destruction Record.

No deficiencies were cited at this time as per California Code of Regulations, Title 22.

This report was reviewed with Administrator Marlene Elliot and a copy of this report was provided.