Facility Evaluation Report

On 06/15/2023, Licensing Program Analysts (LPAs) Arielle Pascua and Christina Valerio arrived unannounced to this facility to conduct as Plan of Correction (POC) visit. LPA Pascua and Valerio were greeted by staff member, Andrea Rush and asked to call the Facility Designated Administrator, Julian Hawes to let him know that CCL was present at this time. Shortly after, LPA Pascua spoke to FDA Hawes via telephone and explained the purpose of the visit. LPA Pascua was informed that FDA Hawes could not make the visit and and asked LPAs to continue the visit with SM Rush. Current Census was 4

The purpose of this visit was to follow up on the prior deficiencies and plan of corrections that were due on 06/05/2023 from a prior case management visit conducted on 06/03/2023.

As of the date of this visit, 06/15/2023, the department had not received any forms or documents to support the plan of the correction and has not been completed by this facility and its designated Administrator at this time.

An immediate civil penalty in the amount of $1,000 was assessed for violations of Sections 80075(b) for the time between 06/06/2023-06/15/2023. This civil penalty was due to not correcting the deficiency that was cited on 06/03/2023. The Facility Designated Administrator 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 via email and an electronic email read receipt confirms receiving these documents.