Facility Evaluation Report

Licensing Program Analyst (LPA) Christine Dolores arrived to the facility unannounced to open complaint investigations. During visit, LPA observed violations and conducted a case management - deficiencies visit. LPA met with Case Manager (CM), Susana Tovar, General Manager (GM), Elaine Sabankaya, and Designated Administrator, Renee Sabankaya.

During visit, LPA requested for residents (R1 - R2) appraisal needs and services plan. The facility was unable to provide the requested documents. Staff states the facility did not develop a needs and services plan for R1 - R2 prior to Admission. Staff state not all clients has a needs and services plan.

LPA asked of the facility's procedures for when a resident is observed to have a change of condition. For any change of condition, the details are written in the resident's progress notes and communicated with the appropriate parties. The residents needs and services plans are also not being updated when there is any change of condition/behavior. During visit, LPA advised the designated Administrator, CM, and GM. All 3 individuals stated understanding.

A deficiency was cited per California Code of Regulations, Title 22. See LIC809D.

This report was reviewed with designated Administrator, Renee Sabankaya and a copy of the report and appeal rights were provided.