Facility Evaluation Report

Licensing Program Analyst (LPA) Kelly Dulek arrived unannounced to conduct a Case Management – Deficiencies visit at this facility. LPA arrived at 10:23AM and met with Administrator Monica Reyes. LPA explained the reason for today's visit. Entrance interview conducted.

Previously, during a visit conducted on 07/07/2023, LPA Dulek had received a copy of the facility's current Admission Agreement. LPA had also previously received and reviewed copies of current residents' Admission Agreements. LPA compared both the copies of residents' Admission Agreements, the blank copy provided on 07/07/2023 and the Admission Agreement that had been submitted with the facility's application and approved at the time of licensure on 05/01/2021. LPA noted the Admission Agreements used with current residents as well the blank copy to be used with new admissions contained discrepancies from the Department approved Admission Agreement.

Pursuant to Title 22 of the California Code of Regulations Division 6, Chapter 8, the following deficiency was cited (refer to LIC 809-D). Failure to correct the deficiency may result in civil penalties.

Exit interview conducted with Administrator Monica Reyes. Today's reports and appeal rights were provided.