Facility Evaluation Report

At approximately 1:05 PM, Licensing Program Analyst (LPA) Magdaleno arrived unannounced to conduct a case management - annual continuation for a required 1-year annual inspection started on 3/9/2026. LPA met with Designee Anabel Tuason. Facility is a Residential Care Facility for the Elderly (RCFE) with six (6) residents in care.

At approximately 1:15 PM LPA conducted a review of six (6) resident records. five (5) of six (6) residents did not have a current Appraisal Needs and Service Plans (deficiency cited). At approximately 2:00 PM LPA conducted review of three (3) staff records. All required documentation present. Facility conducts quarterly disaster drills, and the most recent drill was conducted 2/26. LPA reviewed emergency disaster plan which was last updated 3/26. LPA observed a supply of PPE, emergency supplies, a first aid kit, and flashlights. Facility's fire extinguishers were observed charged and last serviced 3/26. LPA observed required postings were in a prominent area. LPA observed two (2) locked shed in the backyard which were inspected and observed to contain gardening supplies and seasonal decoration.

Updated copies of the following documents were gathered during this visit: Liability Insurance, LIC500 - Personnel Report, LIC308 - Designation of Responsibility

Deficiencies are cited from the California Code of Regulations, Title 22, Division 6 of California Regulation and the Health and Safety Code. Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, or repeat violations within a 12-month period, may result in a civil penalty assessment. Appeal rights were provided. See LIC809D.

Exit interview conducted with Designee, whose signature on form confirms receipt.