Facility Evaluation Report

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit and met with Administrator (ADM) Ariel Palencia. The purpose of the visit was to cite the facility for a deficiency that was found as part of a complaint investigation.

During the investigation, LPA reviewed the Admission Agreement for resident R1. R1's Admission Agreement states R1's admission date was 01/02/2024. R1's signature on the Admission Agreement is dated 01/16/2024. ADM's signature on R1's Admission Agreement is dated 01/02/2024.

During interview on 02/01/2024, ADM stated R1's Admission Agreement was signed on 01/16/2024.

A deficiency was cited as per California Code of Regulations Title 22. See LIC809-D page for more information.

This report was reviewed with ADM Ariel Palencia and a copy of this report and appeal rights were provided.