Facility Evaluation Report

Licensing Program Analyst (LPA) Canela arrived unannounced and met with Licensee, Evelyn Serrano.

During the course of a complaint investigation, LPA discovered the facility failed to report several incidents for R1 to Community Care Licensing as required. Review of medical records also revealed the facility is not properly documenting the centrally stored log as required and the Medication Administration Record that the facility is using, is also not being properly documented.

LPA requested facility to submit paperwork to change the current Administrator, by 6/19/2024.

The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22, Division 6 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 appeal of rights provided.