Facility Evaluation Report

A noncompliance meeting was conducted on 12/03/2024 at CCLD San Jose office. Present at the meeting were San Bruno Adult and Senior Care Regional Manager Vivien Helbling, Licensing Program Manager Romeo Manzano, Licensing Program Analyst Steve Chang, Manuel Monter, Marcela Yanez, facility Administrator Mary Grace Lazaro, facility Licensee Ravenal Cruz, and facility House Manager Annie Rose..

The purpose of the noncompliance meeting was to discuss substantiated complaint allegations. Deficiencies were cited for violations of Title 22 California Code of Regulations on 9/17/2024: 87468.1(a)(2), Personal Rights of Residents in All Facilities and 87211(a)(1)(D), Reporting Requirements

On 05/31/2024 and 9/17/24, the Department conducted investigation regarding an elopement of a resident with developmental disability and neurocognitive disorder. The deficiency issued under Title 22 Regulations 87468.1(a)(2), Personal Rights of Residents in All Facilities was inadvertently issued a Type B instead of Type A. Type A violation is an immediate risk to the safety and health of residents. During the meeting, licensees were informed that the citation issued on 9/17/24, LIC9099-D, Title 22, Code section 87468.1(a)(2) will be amended from Type B to Type A.

Noncompliance Conference Summary LIC 9111 and compliance plans were established during the meeting. The facility will begin a 2-year monitoring plan by licensing which includes more frequent licensing inspections.

Report was reviewed with facility Licensee. A copy of this report, LIC 9111 and LIC 809-D deficiencies were issued and were provided to licensees during today's office visit. During visit, LPA provided a copy of CCL New Dementia Care Regulations Flier and appeal rights were provided.