Facility Evaluation Report

Licensing Program Analyst (LPA) Contreras arrived unannounced to complete required annual inspection and was greeted by licensee Lilia Saddi.

LPA reviewed 3 of 3 resident records. Needs and Service Plan were missing for R2 and R3. In addition, R3 was missing signed Medical Consent (LIC627C) Form and Personal Rights (LIC613C) Form

LPA reviewed 3 staff records. All required documentation was present.

LPA and Admin conducted a spot check of medication and medication records. Medication is centrally stored and Centrally Stored Log up to date.

Facility does not handle P&I monies for residents.

Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Appeal rights given and discussed with Administrator. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties.

Exit interview conducted and report given to Licensee.