Facility Evaluation Report
Capacity6
Census5
Date signed04/18/2024 05:11:45 PM
Licensing Program Analyst (LPA) Zabel Chochian conducted a Case Management - Deficiencies visit due to deficiencies observed during the investigation related to complaint control 29-AS-20230504133547.
Licensee/Administrator did not comply with reporting requirements when resident #1 (R1) eloped from facility on 01/17/2023.
Pursuant to Title 22 Division 6 of the CA Code of Regulations, the following deficiency were cited (refer to LIC 809-D):
Exit interview conducted. Copy of this report and appeal rights provided.
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction