Follow-up on corrections·February 1, 2023

While at the facility for a complaint (Control # 15-AS-20230125080856), Licensing Program Analyst (LPA) Delmundo observed the administrator's signatures on the block designated for the resident and/or responsible person to be signed on resident's (R1) LIC601 Identification and Emergency Contact Information,and LIC625 Appraisal/Needs and Services Plan. LPA asked, and Jonabelle Tolentino, administrator, confirmed it's her signature. Deficiency is cited from Title 22 California Code of Regulations and listed on 809D. Failure to submit proof of correction by plan of correction due date, and any repeat violation within 12 month period may result in civil penalty. Deficiency and plan and proof of correction were discussed with Jonabelle Tolentino. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.