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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 286803028
Report Date: 06/15/2021
Date Signed: 06/16/2021 10:24:41 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:AEGIS ASSISTED LIVING OF NAPAFACILITY NUMBER:
286803028
ADMINISTRATOR:PAUL OSESOFACILITY TYPE:
740
ADDRESS:2100 REDWOOD ROADTELEPHONE:
(707) 251-1409
CITY:NAPASTATE: CAZIP CODE:
94558
CAPACITY:56CENSUS: 47DATE:
06/15/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Paul OsesoTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Angela Elliott met with Paul Oseso General Manager regarding incident for R1 that occurred on 5/25/2021. CCL did not received an incident report, and did receive SOC 341. R1 got into an altercation with staff requiring other staff to intervene. According to General Manager, R1 has previously exhibited aggressive behavior by shouting and General Manager had a conversation with R1 about being kind to people. After altercation with staff, General Manager had another conversation with R1 regarding acceptable behavior at the facility. During admission process documentation does not indicate R1 has behavioral episodes. R1's physician is aware of episode and R1 was previously started on a new medication on 5/6/2021. According to General Manager new medication is for behavior. After incident R1 agreed to comply with facility rules, and there have been no behavioral episodes since. LPA reviewed and requested copies of documentation.

No citations for deficiencies issued.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Angela ElliottTELEPHONE: (470) 717-1668
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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