complaint·October 21, 2021

Page 2 In the areas that were evaluated, no deficiencies were observed of the California Code of Regulations, Title 22, Division 12 at the time of the visit. An exit interview was completed. The report was reviewed and discussed. Appeal Rights were discussed. The facility representative was provided a copy of their appeal rights (LIC 9058 12/15) and their signature on this form acknowledges receipt of these rights. All appeals must be in writing and received by the Licensing office within 15 business days. The facility representative was informed that the \342\200\234Notice of Site Visit\342\200\235 must be posted for 30 consecutive days. Failure to post will result in Civil Penalties of $100.00. The \342\200\234Notice of Site Visit\342\200\235 must be posted on or adjacent to the door.