Facility Evaluation Report

Wrc-1, Ben Lomond07/28/2025Licence 445200582

Capacity34
Census33
Date signed07/28/2025 04:30:29 PM
Name of licensing program analystMarcella Tarin
Name of licensing program managerJin Jackie
The inspector’s account

Licensing Program Analyst (LPA) Marcella Tarin arrived unannounced to conduct a Case Management Incident visit. LPA met with Resident Services Manager (RSM) Elvira Rodriguez. LPA stated the purpose of the visit.

On 7/25/2025 the Department received an incident report regarding an incident involving 3 residents (R1 to R3) that occurred on 7/21/2025.

During visit, LPA requested pertinent documentation to include but not limited to Medication Administration Record (MAR), progress/observation notes, physician's reports, and service plans.

No deficiencies were cited during today's visit per California Code of Regulations, Title 22. An exit interview was conducted with RSM Elvira Rodriguez and a signed copy of this report was provided.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction