Facility Evaluation Report

Licensing Program Analyst (LPA) Manuel Monter arrived unannounced to deliver the results of a complaint investigation 26-AS-20260401123849 . During the complaint investigation, a case management other visit was conducted due to discrepancies discovered during the investigation process. LPA met with Administrator Administrator Karen Nickolai .

On April 13, 2026 the Department requested copies of the hospice notifications that were sent for residents R1-R3.

On April 21, 2026, Health Services Director (HSD) Kyleigh Whitley informed LPA that the hospice notifications were not sent out for residents R1-R3. HSD stated she was unaware that the facility needed to send these hospice notifications to Licensing.

On April 22, 2026, HSD submitted to LPA hospice notification forms for all residents currently under hospice.

LPA also followed up regarding the pending death certificate requests for 4 residents. (R1-R4).

A technical violation is being cited during today's visit per California Code of Regulations, Title 22. See LIC9102. This report was reviewed with Administrator Karen Nickolai and a copy of the report was provided.