Facility Evaluation Report

On 07/24/26 Licensing Program Analyst arrived at the facility to complete an unannounced annual visit. LPA met with Licensee/Administrator, Davilyn Mancilla explained reason for visit and was permitted entry into the facility. LPA completed a tour of the facility inside and out. A health and safety check was completed on residents in care. 2 residents present during time of visit.

Pathways and doors were clear and free from obstruction. Facility was without odor. Common areas were adequately furnished, and adequately lit. Carbon monoxide detector was present and operational at time of visit. Fire extinguisher last serviced 07/20/2026. Last fire drill on conducted on 07/06/2026. Resident rooms observed to have the required furnishings and with adequate lighting. LPA observed sufficient seating under covered patio areas.

The following issues were observed during today’s visit: Facility was having work done to the roof and CCL was not notified. 1 of 1 staff file reviewed did not have the required annual training completed. Facility sketch does not identify assembly points/points. Transportation needs and evacuation procedures are not appropriately reflected. Process for communicating with others is not listed. Annual training on plan is not completed. Deficiencies cited per California Code of Regulations, Title 22, deficiencies are being cited on the attached 809D. If not corrected, the violation with have a direct risk to the health, safety and/or personal rights of residents in care.

LPA requested the following documents to be submitted to CCL by 08/07/26: current copy of Administrator’s Certificate, Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-D), Affidavit regarding Resident Cash Resources (LIC 400), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020), and a current copy of liability insurance in order to update the facility file.

Exit interview was conducted with Licensee/Administrator. A plan of correction was developed by Administrator and reviewed by LPA. A copy of this report, deficiencies, and appeal rights were discussed and provided to Administrator.