Facility Evaluation Report

Licensing Program Analyst (LPA) Cuadra arrived unannounced , to conduct a Plan of Correction (POC) visit. On 10/17/2025, LPA issued two citations for a violation of California Code of Regulation section 87211(a)(2) and 87506 (d)(e) with a plan of correction (POC), which are outstanding as of today.

One out two POC called for the Licensee to provide training to all Staff reviewing the Regulation: 87211 (a)(2) Reporting Requirements. In-service Training to include the following information: Date of Training, Training Topics, Job Role, Staff Names and Signatures. Training to be submitted to CCL for review and approval by POC due date of 10/31/25. During today's visit, Licensee provided proof of correction for citation 87211 (a)(2)- Deficiency cleared from case management visit 10/17/2025. Copies of documents obtained.

The second POC called for the Licensee to review regulation 87506 regarding resident records and retain at the facility resident's records to be available to the licensing agency for review as stated per regulation and Licensee agreed to submit documents requested by POC due date 10/31/25. Today, Licensee could not provide proof to clear citation 87506 (d)(e) and documentation for residents (R1) including Physician's Report (LIC602), daily chart notes and care plan were not available for LPA to review. ***The facility will be assessed a civil penalty for $100 per day for the period of 10/31/2025 to 11/6/2025 totaling $700. The civil penalty will continue to accrue $100 per day until the deficiency is corrected.

Deficiencies are cited from the California Code of Regulations (CCRs), Title 22, Division 6, Chapter 8 and the Health and Safety Code. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Appeal Rights Given.

Exit interview with Licensee and copy of this report was given.