Facility Evaluation Report

At approximately 1:55 PM Licensing Program Analyst (LPA) Nakagawaarrived unannounced to conduct a case management visit in addition to a complaint invetigation. Facility serves residents with dementia and has a plan of operation for dementia care and programming on file.

During walk-through LPA observed table blocking the exterior exit door in Bedroom #7 which is a violation of fire regulation.

Deficiencies are cited from the California Code of Regulations (CCRs), and/or the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

***An immediate civil penalty in the total amount of $500.00 has been issued for being out of compliance with fire clearance regulation 87202(a).

Exit interview conducted. Copy of report, LIC809D, LIC421IM, Plan of Corrections, and Appeal Rights discussed and provided to Administrator. Signature on form confirms receipt of documents.