Facility Evaluation Report

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced Case Management - Other visit to follow up on health and safety of the residents in care, following the plan of correction submitted for the deficiencies cited on 12/27/2024. LPA met with Administrator, Kiros Woldegiorgis and stated the purpose of the visit.

During today's visit, LPA Rai observed 4 staff present at the facility, including the Administrator, and 6 residents were present at the facility. ADM stated there is 1 resident that requires 1:1 care and supervision. ADM stated three staff scheduled is sufficient to provide care and supervision for the needs of the residents at this time.

Based on review of LIC 500, 3 staff are assigned for the current shift from 2pm-6pm and were present at the facility.

Based on review of the staffing schedule submitted to San Andreas Regional Center, 3 staff are assigned for the current shift 2pm-6pm and were present at the facility.

No deficiencies were cited per California Code of Regulations, Title 22.

This report was reviewed with Administrator, Kiros Woldegiorgis and a copy of the report was provided.