Follow-up·November 15, 2021

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced Case Management visit at the facility, to complete a health and safety check for clients in care. LPA identified herself and was granted entry by Aurora Lopez, Caregiver. LPA met with Siklatic Garcia, Facility Manager and disclosed the purpose of the visit. The facility self-reported an incident regarding Resident 1 (R1) (See LIC 811 Confidential Names List) to Community Care Licensing on November 5, 2021. During today's visit, LPA toured the facility, spoke with staff, residents and Licensee, and reviewed and obtained resident records maintained by the facility. No immediate health or safety concerns were observed. No deficiencies were cited during today’s visit. An exit interview was conducted with Facility Manager Garcia, and a copy of this report, along with Licensee/Appeal Rights (LIC 9058 01/16), was provided to the Quezalli Khanis Licensee and Facility Manager Garcia via electronic mail. An electronic read receipt confirms the documents were received.