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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701286
Report Date: 08/12/2026
Date Signed: 08/12/2026 07:04:46 PM

Document Has Been Signed on 08/12/2026 07:04 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:BEATRICE HOME CAREFACILITY NUMBER:
342701286
ADMINISTRATOR/
DIRECTOR:		CLARK, BEATRICEFACILITY TYPE:
740
ADDRESS:1014 FERNANDO WYTELEPHONE:
(916) 270-3961
CITY:GALTSTATE: CAZIP CODE:
95632
CAPACITY: 6CENSUS: 5DATE:
08/12/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:55 AM
MET WITH:Beatrice Clark, AdministratorTIME VISIT/
INSPECTION COMPLETED:
07:10 PM
NARRATIVE
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Unannounced Annual Inspection visit was made by Licensing Program Analyst (LPA) Kimberly Viarella to this facility on 08/12/26. LPA identified herself to the Caregiver on duty, explained the purpose of the visit, and asked to speak with Licensee/Administrator. Staff called the Administrator, Beatrice Clark, who told this LPA that she would arrive in approximately 20 minutes.

LPA was met by a worker who was left alone with a resident unsupervised. This individual was not background cleared. This deficiency was cited on the LIC 809D page.

The inspection began in the kitchen. All knives and sharps were locked and inaccessible to residents in care. The food supply was adequate for 2-day perishable and 7-day nonperishable. There were two opened jars of peanut butter and an open bottle of BBQ sauce in the refrigerator. LPA pulled a sample of 5 refrigerated items and 5 pantry items and checked for expiration dates. None were expired, but this LPA observed an open bag of rice and an open bag of flour. LPA also observed a jar of sugar with ants in the cabinet. Deficiencies for food storage and pests were cited on the LIC 809 D page



This facility was licensed for 6 residents, 5 of whom may be non-ambulatory. Bedrooms 1,2,3 and the master approved for non-ambulatory. Bedroom 4 approved for ambulatory only. Hospice waiver for 2. LPA inspected the 4 resident bedrooms, 2 bathrooms, and all common areas as well as the garage.

LPA noted soap, paper towels and trash cans with lids in bathrooms. The hot water temperature was measured at 103.6 degrees Fahrenheit and was not in compliance. The 2 fire extinguishers were last serviced on 03/11/26 by Jorgensen Co. and was also in compliance.



Lisa Rios
Kimberly Viarella
DATE: 08/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/12/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 15
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: BEATRICE HOME CARE
FACILITY NUMBER: 342701286
VISIT DATE: 08/12/2026
NARRATIVE
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The exterior of the building was inspected by the LPA. There were no bodies of water present and the yard was completely fenced in. LPA observed the screen on the master bedroom sliders was missing and a shaded area with chairs for residents to enjoy.

During today's walkthrough, LPA observed a drawer in the kitchen missing its handle as well as handles missing of drawers in residents rooms. The cabinet under the sink was also missing its handle and the light switch in the bathroom was broken. These deficiencies were cited on the LIC 809D page.

The LPA observed the medication cabinet was left open and accessible to residents. This deficiency was cited on the LIC 809D page. A review of the First Aid kit by the LPA found it to be complete and in compliance.

LPA reviewed a resident file and found that the last LIC 602 was dated 2023. This resident had a change of condition and a new one was overdue. This deficiency was cited on the LIC 809D page A review of the file for the caregiver on duty was also completed. Their file was missing a health clearance and proof of CPR / First Aid certification. The Administrator did not have a copy of her file at the facility for me to review. That deficiency was cited as well.

According to the California Code of Regulations, Title 22, all deficiencies were cited on the LIC 809 D page, however due to time constraints, this LPA will have to return at a later date to assess civil penalties. A copy of this report was provided along with APPEAL RIGHTS and an exit interview was conducted with Clark.
NAME OF LICENSING PROGRAM MANAGER: Lisa Rios
NAME OF LICENSING PROGRAM ANALYST: Kimberly Viarella
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2026
LIC809 (FAS) - (06/04)
Page: 3 of 15
Document Has Been Signed on 08/12/2026 07:04 PM - It Cannot Be Edited


Created By: Kimberly Viarella On 08/12/2026 at 05:25 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BEATRICE HOME CARE
FACILITY NUMBER: 342701286

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/12/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87466
Observation of the Resident
The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. When changes such as unusual weight gains or losses or deterioration of mental ability or a physical health condition are observed, the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person, if any.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, a resident had an open wound on their leg and partially ripped off toe nail and the resident was not sent out for immediate medical evaluation. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/12/2026
Plan of Correction
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The Administrator sent the resident out for a medical evaluation. This POC has been cleared.
Type A
Section Cited
CCR
87202(a)
Fire Clearance
(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the Administrator and staff use a shoe to prop open a fire door. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/12/2026
Plan of Correction
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Administrator stated that the shoe will be removed and the door willnot be prepped open.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lisa Rios
NAME OF LICENSING PROGRAM MANAGER:
Kimberly Viarella
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/12/2026


LIC809 (FAS) - (06/04)
Page: 4 of 15
Document Has Been Signed on 08/12/2026 07:04 PM - It Cannot Be Edited


Created By: Kimberly Viarella On 08/12/2026 at 05:25 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BEATRICE HOME CARE
FACILITY NUMBER: 342701286

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/12/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87303(c)
Maintenance and Operation
(c) All window screens shall be clean and maintained in good repair.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the master bedroom was missing its slider screen. On 08/10/26 when this LPA was here last the door was wide open and this LPA has observed pests in the faciltiy, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/12/2026
Plan of Correction
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The Administrator stated she will schedule another pest control appointment abd will email the infomation to CCL by the close of business 08/13/26.
Type A
Section Cited
HSC
1569.618(c)(3)
Other Provisions
(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on onservation and record review, this LPA couldn not review proof of any of the 2 staff being CPR/ First AiD cerified at this facility. This poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/13/2026
Plan of Correction
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Administrator stated they will supply proof of First Aid /CPR certification or registration of class by close of business tomorrow, 08/12/26
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lisa Rios
NAME OF LICENSING PROGRAM MANAGER:
Kimberly Viarella
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/12/2026


LIC809 (FAS) - (06/04)
Page: 5 of 15
Document Has Been Signed on 08/12/2026 07:04 PM - It Cannot Be Edited


Created By: Kimberly Viarella On 08/12/2026 at 05:25 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BEATRICE HOME CARE
FACILITY NUMBER: 342701286

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/12/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87465(h)(2)
Incidental Medical and Dental Care Services
(h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on this LPA's observations, the medicaiton cabinet was left open and accessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/12/2026
Plan of Correction
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Administrator will sign a declaration stating that they understand that the medication cabinet must be locked at all times. This willbe sent to CCL by the close of business tomorrow.
Type A
Section Cited
CCR
87355(e)


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based observation and interview the licensee did not comply with the regulation above when this LPA was met by a worker who was not associated to the facility and who was left unsupervised with residents in care. This posed an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/13/2026
Plan of Correction
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The Administrator will submit a letter of understanding stating that she will no longer allow wokers to be left unsupervised with residents in care.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lisa Rios
NAME OF LICENSING PROGRAM MANAGER:
Kimberly Viarella
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/12/2026


LIC809 (FAS) - (06/04)
Page: 6 of 15
Document Has Been Signed on 08/12/2026 07:04 PM - It Cannot Be Edited


Created By: Kimberly Viarella On 08/12/2026 at 05:25 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BEATRICE HOME CARE
FACILITY NUMBER: 342701286

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/12/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87470(a)(2)(B)
Infection Control Requirements
(2) Environmental cleaning and disinfection activities shall be performed following the manufacturers'instructions for proper use of the cleaning and disinfecting products. These activities shall be completed, at a minimum, as follows: (B) Walls and window coverings in resident care areas shall be dusted or cleaned on a regular schedule to ensure they are safe and sanitary and when they are visibly contaminated or soiled.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, this LPA observed reddish brown stains on the wall and furniture in bedroom 4 which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/31/2026
Plan of Correction
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Administrator stated they will clean and disinfect the room by 08/31/26. Pictures will be sent to CCL as proof of correction.
Type B
Section Cited
CCR
87208(a)
Plan of Operation
(a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview, the Administrator did not have a copy of her plan of operation at the facility. This poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/31/2026
Plan of Correction
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Administrator stated theywill have a copy of the plan of operation here 08/31/26.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lisa Rios
NAME OF LICENSING PROGRAM MANAGER:
Kimberly Viarella
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/12/2026


LIC809 (FAS) - (06/04)
Page: 7 of 15
Document Has Been Signed on 08/12/2026 07:04 PM - It Cannot Be Edited


Created By: Kimberly Viarella On 08/12/2026 at 05:25 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BEATRICE HOME CARE
FACILITY NUMBER: 342701286

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/12/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.157(h)
Licensing
(h) The text of this section with the heading “Rights of Resident Councils” shall be posted in a prominent place at the facility accessible to residents, family members, and resident representatives.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above as they did not have the Rights of Resident Councils posted which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/31/2026
Plan of Correction
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2
3
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Administrator stated they will post the Rights Councils where they are visible by the date above.
Type B
Section Cited
CCR
87303(a)
Maintenance and Operation
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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2
3
4
Based on observation, the light switch in the bathroom was broken and there was a drawer in the kitchen missing a knob and the bathroom cabinet was also missing its handles which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/31/2026
Plan of Correction
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Admistrator stated they will make repairs by 08/31/26.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lisa Rios
NAME OF LICENSING PROGRAM MANAGER:
Kimberly Viarella
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/12/2026


LIC809 (FAS) - (06/04)
Page: 8 of 15
Document Has Been Signed on 08/12/2026 07:04 PM - It Cannot Be Edited


Created By: Kimberly Viarella On 08/12/2026 at 05:25 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: BEATRICE HOME CARE
FACILITY NUMBER: 342701286

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/12/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87303(e)(2)
Maintenance and Operation
(2) Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degrees C) and not more than 120 degree F (49 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and testing, the hot water took approximately 7 minutes to reach a temperature of 103.6 degrees F. which poses/posed a potential health, safety or personal rights risk to persons in care. After using the restroom people should be able to access hot water in a timely manner to wash their hands.
POC Due Date: 08/31/2026
Plan of Correction
1
2
3
4
Administrator will turn the hot water up and keep a temperature log for two weeks and ill submit a copy to licensing by 08/31/26.
Type B
Section Cited
CCR
87468(c)
Personal Rights of Residents
(c) Licensees shall prominently post personal rights, nondiscrimination notice, and complaint information in areas accessible to residents, representatives, and the public.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
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Based on observation, the above were not posted poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/31/2026
Plan of Correction
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Administrator stated she will post personal rights of residents and she will send a picture for proof of correction.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Lisa Rios
NAME OF LICENSING PROGRAM MANAGER:
Kimberly Viarella
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/12/2026


LIC809 (FAS) - (06/04)
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