Facility Evaluation Report

Licensing Program Analyst (LPA) David Marrufo conducted an unannounced Case Management visit and met with Andreas Fernandez.

During visit, LPA Marrufo requested that the following documents be submitted to CCL within 24 hours for residents R1-R5:

Most current Physician's Report, Admission Agreement, most current IPP Assessment (if applicable), Incident Reports from the last 6 months, and Case Notes.

LPA Marrufo also requests the following documents be submitted to CCL within 24 hours for staff S1-S5:

LIC501, training records, Staff write-ups, and Employment Application.

LPA requests the following facility records be submitted to CCL within 24 hours:

Current Administrator Certificate, Actual Staff Schedule from March and April 2024, and Resident Roster.

LPA conducted a wellness check with the three residents who were present during visit.

No deficiencies were cited at this time as per California Code of Regulations Title 22. This report was reviewed with Andreas Fernandez and a copy of this report was provided.