Facility Evaluation Report

Licensing Program Analyst (LPA) Jill Nakagawa arrived unannounced to conduct an investigation. There were 2 care staff and 4 residents at the time of inspection.

Facility was found to be clean and well organized. It was a comfortable temperature. Residents were clean and dressed appropriately. There was an ample supply of hygiene supplies for residents' care. There was also an ample supply of perishable and non-perishable food as required by Title 22.

During investigation it was found that Administrator's Certificate has expired. LPA checked the list of pending and active certificates and Administrator's name was not found.

In addition, LPA reviewed resident records and found no current orders for 1/2 bed rails for 3 of 3 residents with bed rails.

The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6, Chapter 8 of California Regulation. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted and a copy of this report along with appeal rights were emailed to the Administrator due to printer issues.