Facility Evaluation Report

On 08/11/2025, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA was greeted by Facility Staff, Maria Fe Peterson and explained the purpose of the visit. LPA Pascua asked Facility Staff Peterson to call the Facility Designated Administrator (FDA), Quincy Beltran to inform them that CCL was present. Shortly after, LPA met with FDA Beltran explained the purpose of the visit. There was one other staff present at the facility, May Ann Langcao.

This facility is licensed to served and accept up to 6 residents who are deemed to be non-ambulatory only. This facility is also vendorized to accept and retain Level 5 residents at this time.

Census was currently at 4. 3 out of 4 residents were out at their respective day program. A brief interview with, FDA Beltran was conducted.

LPA reviewed 4 resident files. 4 out 4 resident files were complete and up to date. LPA reviewed 4 staff files. 4 out of 4 staff files were complete and up to date. In addition, a review of a recent incident report was reviewed with the facility. On June 21, 2025, facility staff took residents on an outing. During transport, one resident unbuckled their seat belt and subsequently fell to the floor of the van while still in their wheelchair. A review of the resident’s Individual Program Plan (IPP) did not indicate a history or tendency of unbuckling their seat belt. However, further staff interviews revealed that such behavior had been reported to the resident's Service Coordinator as early as October 2024. Following this incident, both the administrator and the LPA agreed that an updated plan would be developed to address the resident’s behavior. Additionally, the resident's IPP will be revised to reflect this updated information.

Fire extinguisher located by the dining room appeared to have been annually inspected by the Cal-State Fire on 04/17/2025.