Facility Evaluation Report

Licensing Program Analyst (LPA) Angel Ascencio conducted a Case Management - Deficiency visit to the above facility. LPA Ascencio met with Administrator Cinthia Meza at 11:45 AM.

On 5/10/2022, starting at approximately 12:15 p.m., LPA Ascencio reviewed resident files and observed Resident #1 (R1) did not have a Pre-Admission Appraisal. Admin stated they are not sure why they do not have one for the resident. Later that same day, at approximately 12:25 p.m., the LPA did not observed an updated Need and Service plan for R2, R3, R4 for a change in condition. Admin stated that they communicated with the family about the needs verbally. Admin added they were not aware responsible party needed to signed the needs and service plan.

2 citations were issued during today’s visit. The following deficiencies were observed (See LIC 809-D.) and

cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to

correct the deficiencies may result in civil penalties.

Copy of the report and appeal rights provided to Admin via email.