Facility Evaluation Report

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced case management visit to address the deficiencies observed during a complaint investigation on 01/16/2026. LPA Rai met with Administrator, Syeda Haroon and stated the purpose of today's visit.

During the complaint investigation, LPA Rai reviewed three resident's file (R1-R3) whose LIC 625 Appraisal/Needs and Services Plan was created by Administrator but it was not signed by resident or resident's responsible party. LPA Rai review one resident's file (R1) whose LIC 602A Medical Assessment for Residential Care Facilities for the Elderly was completed on 02/16/2026 after R1 was moved into the facility on 01/09/2026.

During today's visit, Administrator stated R1's physician was hard to get a hold of prior to R1 moving into the facility and Administrator attempted for R1 to be seen by physician and obtain a medical assessment. Administrator stated R1's physician came to the facility on 02/16/2026 and assessed R1 at the facility.

During today's visit, LPA Rai spoke with resident R1's responsible party (F1) who signed R1's LIC 625 Appraisal/Needs and Services Plan. F1 stated they had a hard time obtaining the LIC 602A from R1's physician prior to moving the resident into the facility. F1 stated R1's physician visited R1 at the facility and completed the medical assessment on 02/16/2026.

Deficiencies were cited per California Code of Regulations, Title 22. See LIC 809-D. Failure to correct the cited deficiency, on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment. This report was reviewed with Administrator, Syeda Haroon and a copy of the report was provided. Appeal Rights were provided.