Facility Evaluation Report

Licensing Program Analyst (LPA) Erik Gonzalez Campos arrived unannounced at approximately 10:30 AM to conduct a case management inspection. LPA was greeted by administrator and asked to sign in after symptom screening.

LPA toured facility with administrator and observed damaged floorboards near nursing station, in hallway accessible to clients and in client bedroom. Floorboards in hallway are separated and can be lifted. Floorboards in client bedroom appear bowed. Photos taken.

LPA also reviewed staffing schedule. Registered nurse was awake and available for at least 40 hours per week in 3 of 4 weeks during the month of January.

Exit interview conducted with administrator and a copy of this report printed for the facility.

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