Facility Evaluation Report

On 10/20/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct a Plan of Correction (POC) visit.. LPA was greeted by Staff Member (SM), Carlette Sharpe and explained the purpose of the visit. SM Sharpe notified the Facility Designated Representative (FDR), Nicolette Taylor that CCL was present. SM Sharpe notified LPA Pascua that FDR Taylor would be arriving shortly. LPA Pascua asked SM Taylor to contact the Facility Designated Administrator (FDA), Iboni James to inform them that CCL was present. It was learned that FDA James was unable to be reached during the time of this visit.

Current census was 3. A brief interview with SM Taylor was conducted.

The purpose of this visit was to follow up on the prior deficiencies and plan of corrections that were due on 10/10/2025 from a prior complaint visit conducted on10/09/2025. As of the date of this visit, 10/19/2025, the department has not received any forms or documents to support that the plan of correction has been completed by this facility and its designated Administrator at this time.

· A civil penalty in the amount of $1,000 was assessed for violations of Section 80019(e)(2) for the time between 10/11/2025-10/20/2025. This civil penalty was due to failure to correct the deficiency by the Plan of Correction date 10/10/2025. The Facility was informed that the civil penalty will continue to accrue $100 per day per violation until the deficiency is corrected.

An exit interview was conducted and a copy of this report was provided to the facility at the end of this visit.