Victoria's Place

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analyst (LPA) Cuadra conducted an unannounced case management Legal/ Non-compliance inspection to this facility and met with administrator Azeneth Gregoire. LPA was following up on items that were concerning and ensure compliance with Non-Compliance Conference dated 03/18/2026: 87465 Incidental Medical and Dental Care (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis. During today’s visit, LPA reviewed incident logs received from the facility which appears that staff had been responding timely to medical emergencies. However, the department received a self-incident report about resident (R1) who eloped the facility on 8/14/26 at night was found by a neighbor which called the ambulance to take them to the hospital for further evaluation. Administrator was notified by the hospital that R1 was there and they went to pick them up to bring them back to the facility. According to administrator, the facility have painted the walls, door alarms were removed to let the walls to dry out, and R1 who has a diagnosis of dementia was able to walk away from the facility without staff's knowledge. Per discharge documents attached to incident report confirmed that R1 has a diagnosis of dementia, apparently had a fall, they were taken by ambulance to the emergency room where testing performed were normal and got discharged back to the facility. Based on records review and interviews with administrator, facility polices and procedures regarding AWOL/Elopement were not followed. R1 does not have a needs or service plan for review during today's inspection. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. ***civil penalties in the amount of $250 are issued due to repeated citation within 12 months. Appeal rights given. Exit interview conducted with administrator and copy of this report was given.the state’s words, verbatim · CDSS document, Sep 10, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(d) · Plan of correction due date: Sep 11, 2026

87705 Care of Persons with Dementia: (d) The licensee shall ensure that the facility has an auditory device or other staff alert feature to monitor exits on exterior doors... accessible to those residents who may be at risk for elopement...This requirement was not met as evidence by: Based on record review and interviews with administrator, Licensee did not ensure that staff were aware that R1 left the facility without assistance. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Sep 10, 2026

Plan of correction: Facility will conduct elopement refresh training with all staff and will submit proof of training to CCL to clear the citation by POC due date 09/11/26.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87463 · Plan of correction due date: Sep 24, 2026

87463 Reappraisals (i) When there is significant change in condition, ...or once every 12 months, whichever occurs first, the licensee shall arrange an in-person or virtual meeting or conference call to share the reappraisal with the resident, the resident's representative, if applicable, and appropriate facility staff...This requirement was not met as evidence by: Based on LPA’s records review and interviews with the administrator, licensee failed to develop a care plan for R1 who has a diagnosis of dementia since their admission on 1/31/26, which poses a potential risk to the health and safety of the residents.the state’s words, verbatim · CDSS document, Sep 10, 2026

Plan of correction: Administrator agrees to review all residents’ care plans to ensure that they have care plans documented every 12 months, and will submit a self-certification form (LIC9098) to CCL by POC due date to clear the deficiency. ***civil penalties in the amount of $250 are issued due to repeated citation within 12 months.

Type of visit: Case Management - Legal/Non-compliance

Licensing Program Analyst (LPA) Cuadra conducted an unannounced case management Legal/ Non-compliance inspection to this facility and met with Administrator Azeneth Gregoire. LPA was following up on items that were concerning and ensure compliance with Non-Compliance Conference dated 03/18/2026: 87465 Incidental Medical and Dental Care (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis. – After resident had a significant change of condition, but no medical attention was sought timely by the facility staff. During today’s visit, LPA reviewed incident logs received from the facility which appears that staff had been responding timely to medical emergencies. Upon LPA's arrival, LPA discovered that there was an auditory monitor in R1's room that could be heard on a monitor in the kitchen. According to administrator, the resident's responsible party requested the facility to monitor with baby monitor since R1 is unable to ring the bell for assistance. LPA explained the regulation to the administrator regarding personal rights and how their family cannot take away R1's personal rights. The facility needs to find an alternative option that do not constitute a violation of R1's personal rights. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Exit interview conducted with administrator and copy of this report was given.the state’s words, verbatim · CDSS document, Jun 9, 2026

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(1) · Plan of correction due date: Jun 10, 2026

Additional Personal Rights of Residents in Privately Operated Facilities - To have a reasonable level of personal privacy in accommodations, medical treatment, personal care & assistance, visits, communications, telephone conversations, use of the Internet...This requirement has not been met as evidenced by LPA's/administrator observation an auditory monitor was being used to monitor R1's room. This does not allow for privacy. This is an immediate risk to the personal rights of residents in care.the state’s words, verbatim · CDSS document, Jun 9, 2026

Plan of correction: Administrator agrees to remove monitor immediately by POC due date. Administrator will conduct staff training with all staff subsequently and submit proof of training to CCL within two weeks.

Type of visit: Office

A non-compliance conference was conducted today in the Santa Rosa Regional Office. Present at the meeting were Regional Manager, Carla Nuti-Martinez, Licensing Program Manager Bethany Moellers, Licensing Program Analyst Marisol Cuadra, Orr Chistiakoff, staff and Conchita Mejia-Chistiakoff, Licensee. The purpose of today's meeting is to discuss concerns that have been identified by the Licensing Agency regarding the operation of this facility during complaint investigation conducted by the Department that has been substantiated in complaint # 21-AS-20251027230602 about staff did not seek medical care for resident in a timely manner violation due to the facility staff informed Orr Chistiakoff who is the Licensee's designated representative that a resident have experienced a significant change of condition, but no medical attention was seek timely by facility staff. An immediate civil penalty of the amount of $500 was issued during the complaint findings visit. During today’s meeting the following were discussed: - Staff did not seek medical care for resident in a timely manner. According to Licensee, the following preventive measures have been implemented to ensure timely medical is seek after any resident exhibits a significant change of condition staff were instructed to take action immediately telephone 911 if any injury or other circumstance in residents is observed. The licensee was informed that additional civil penalties are under review by the Department by the Health and Safety Code 1569.49 (f). Licensee was informed of technical support program and agrees to engage in services. No deficiencies cited for this facility. Exit interview conducted with Licensee and a copy of this report was given.the state’s words, verbatim · CDSS document, Mar 18, 2026

Allegation investigated: -Staff did not seek medical care for resident in a timely manner.

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a complaint investigation and delivered findings regarding the allegation listed above and met with Azenethe Gregoire, Administrator. There was an allegation of staff did not seek medical care for a resident in a timely manner. According to Reporting Party, resident (R1) was presented to the hospital at 11:41am on 10/27/2025 with concern for stroke-like symptoms and emergency personnel (unknown name) disclosed that R1's last known well was on 8:00 pm the evening prior, but the facility staff called the paramedics around 11am next day, when they noticed that R1 was not acting at their baseline leading to reporting party assumed that staff had not checked on R1 for 15 hours, or they did not seek emergency medical treatment when they first noticed their change in neuro status. Based on records, a review of medical records obtained by the Department revealed that R1 arrived at the hospital and was diagnosed with cerebrovascular accident (CVA) due to embolism of left middle cerebral artery, pressure ulcer of right buttock, stage 2 and pressure ulcer of left buttock, stage 1. Continue on LIC9099C... Substantiated Continued from LIC9099... LPA conducted confidential interviews with Licensee and facility staff (S1, S2 & S3) revealed conflicting information regarding the timeline and services provided to R1. LPA conducted interviews with residents (R2, R3 & R4) confirmed that staff check them regularly during night shift. According to interviews conducted by LPA with S3, R1 and all other residents were checked hourly. Per S3, the night before R1’s hospitalization, R1 was described as not engaged like R1 used to make gestures to respond to questions, but when they performed their last check at 5am, R1 was observed sleeping, breathing without any signs of distress. Investigation revealed that facility morning staff (S1 & S2) found R1 at around 7:30am when they performed their usual rounds to check on residents, R1 was observed with a significant change of condition, which prompted S1 to call the Licensee immediately. According to interviews conducted with the Licensee, the facility staff informed them about the significant change in condition of R1. Although R1 was observed with signs of distress at about 7:30am, LPA obtained Santa Rosa Fire Department records revealed that they were not contacted until they received emergency call on 10/27/25 at 11:08:54am to transport R1 to the hospital. The preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 8), is cited on the attached LIC 9099D. Appeal Rights Given. Failure to seek medical care resulted in violation causing injury to person in care $500 immediate civil penalty issued. The licensee was informed that additional civil penalties are under review by the Department per Health and Safety Code 1569.49 (f). Continued from LIC9099A... However, medical records revealed that R1 was bed-bound and receiving home health services for wound care since September 2, 2025. Although R1 clearly had a change of condition and ambulatory status requiring frequent reposition, the facility did not obtain an updated physician report and care plan. Furthermore, R1’s medical records revealed that on 9/10/25, R1 was transported to the emergency room with acute severe ankle problem due to a fall while they were getting out of the bath and fell twisting the left ankle, it was unclear in the after visit summary if R1’s was still ambulatory or not, but LPA reviewed incident report logs for this facility and the fall nor the hospitalization was not reported to the Department as stated in regulations. On 12/18/25 at approximate 8:56am, Licensee contacted LPA to notify the Department that R1 passed away while in the hospital after two days hospitalized due to a massive stroke. LPA inquired about reporting requirement, but Licensee stated that they have mailed the required death report, but LPA did not receive it until 1/2/26. LPA will address both deficiencies in case management. According to R1’s medical records, R1 was receiving home health services for wound care on 9/2/25, 9/4/25, 9/8/25, 9/11/25, 9/15/25, 9/18/25, 9/22/25, 9/25/25, 9/29/25, 10/2/25, 10/6/25, 10/9/25, 10/13/25, 10/16/25, 10/21/25, 10/22/25 and 10/24/25. Based on interviews conducted with Licensee confirmed that home health has been providing wound care services to R1 for the past couple of months and a nurse had been coming out normally it was once or twice a month, then visits were increased to twice a week, when skin deterioration and wounds were not getting better. Per Licensee, R1’s wounds were never staged because it started a little reddish, then it will heal, until it got to a point where they were not healing and last Friday (10/24/25), home health notified them that a wound specialist was scheduled to come on Monday (10/27/25), but R1 was not seen due to hospitalization. LPA conducted interviews with third party agency individual (I1) who confirmed that they were providing wound care services to R1 on average twice per week, the facility reported to them about R1’s pressure injuries were developing very rapidly. Per I1, R1’s wounds for one week were manageable, but the following week their wounds were significantly bad, and they were not getting better, but there were no concerns raised regarding the care or staff training that the facility provided for R1. Based on the information obtained by the Department during this investigation, the facility assisted R1 with care and reported changes of condition to the assisting agency. A finding that the allegation of lack of care from staff resulted in resident sustaining pressure wounds while in care is unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.the state’s words, verbatim · CDSS document, Feb 12, 2026 · control 21-AS-20251027230602

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(g) · Plan of correction due date: Feb 13, 2026

87465 Incidental Medical and Dental Care (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis...This requirement has not been met as evidence by: Based on interviews conducted with facility staff and records reviews of fire department service calls, the facility staff failed to seek medical attention after observing R1’s significant change of condition at 7:30am, which poses an immediate risk to the health and safety of the residents in care.the state’s words, verbatim · CDSS document, Feb 12, 2026

Plan of correction: The Licensee agrees to develop a procedure that it will be attached to the facility plan of operation indicating how the facility will ensure that facility staff will immediately telephone 9-1-1 after learning that a resident sustain an injury or other circumstance that could resulted in an imminent threat to a resident’s health or any significant change of condition and care needs by POC due date. ***Failure to seek medical care resulted in violation causing injury to person in care $500 immediate civil penalty issued.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Cuadra conducted a case management visit to cite deficiencies discovered during a complaint investigation and met with Azenethe Gregoire, Administrator. LPA learned through records review and interviews with Licensee the facility has failed to obtain an updated physician’s report (LIC602) and care plan for resident (R1) after they have a significant change of condition and ambulatory status. According to R1’s physician’s report (LIC602) dated 12/4/22, R1 had a diagnosis of dementia, they were ambulatory, they did not have a history of skin breakdown and did not require reposition. However, medical records obtained by the Department revealed that R1 was bed-bound and receiving home health services for wound care since September 2, 2025. Although R1 clearly had a change of condition and ambulatory status requiring repositioning of the resident due to bed-bound status, the facility did not obtain an updated physician report and care plan. Furthermore, R1’s medical records revealed that on 9/10/25, R1 was transported to the emergency room with acute severe ankle problem due to a fall while they were getting out of the bath and fell twisting the left ankle, it was unclear in the after visit summary if R1’s was still ambulatory or not, but LPA reviewed incident report logs for this facility and the fall nor the hospitalization was not reported to the Department as stated in regulations. On 12/18/25 at approximate 8:56am, Licensee contacted LPA to notify the Department that R1 passed away while in the hospital after two days hospitalized. LPA inquired about reporting requirement regulation, but Licensee stated that they have mailed the required death report, but LPA did not receive it until 1/2/26. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties. Exit interview conducted with Administrator and copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 12, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(2) · Plan of correction due date: Feb 27, 2026

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports.: (2) Occurrences, such as...major accidents which threaten the welfare, safety or health of residents..., shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate. This requirement was not met as evidence by: Based on LPA’s records review and interviews with the Licensee, the facility failed to notify the Department about R1’s hospitalization on 9/10/25 and R1’s death on 10/31/25, which could pose a potential risk to the health and safety of residents in care.the state’s words, verbatim · CDSS document, Feb 12, 2026

Plan of correction: Licensee agrees to review reporting requirements regulation, conduct training with all staff about reporting requirements, and will submit a written policy about the process that staff will follow to ensure that incidents are reported timely to CCL as proof of correction to clear the deficiency by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87463 · Plan of correction due date: Feb 27, 2026

87463 Reappraisals (i) When there is significant change in condition, ...or once every 12 months, whichever occurs first, the licensee shall arrange an in-person or virtual meeting or conference call to share the reappraisal with the resident, the resident's representative, if applicable, and appropriate facility staff...This requirement was not met as evidence by: Based on LPA’s records review and interviews with the Licensee, the Licensee failed to update R1’s care after they had a significant change of condition, which poses a potential risk to the health and safety of the residents.the state’s words, verbatim · CDSS document, Feb 12, 2026

Plan of correction: Licensee agrees to review all residents’ care plans to ensure that any change of condition observed is documented and once every 12 months, whichever occurs first is notified to the residents’ responsible party, then the Licensee will submit a self-certification form (LIC9098) to CCL by POC due date to clear the deficiency.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87466 · Plan of correction due date: Feb 27, 2026

87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes in physical, mental..., the licensee shall ensure that such changes are documented & brought to the attention of the resident's physician and the resident's responsible person, This requirement has not been met as evidence by: Based on LPA’s records review and interviews with the Licensee, LPA learned that Licensee failed to obtain an updated physician’s report (LIC602) for R1 after they have a significant change of condition and ambulatory status, which poses a potential risk to the health and safety of the residents in care.the state’s words, verbatim · CDSS document, Feb 12, 2026

Plan of correction: Licensee agrees to review all residents’ care plans to ensure that all the residents have updated medical assessments including any change of condition are documented and brought to the attention of the resident’s physician and resident’s responsible person. Licensee will submit self-certification form (LIC9098) that all residents have current medical assessments on file by POC due date.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required Inspection and met with back up administrator, Azenette Gregoire. Annual fees are current. LPA/staff initiated a tour of the facility at 9:00 am and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Water temperature in resident's bathroom measured at 113.1 and 113.8 degrees F which are within allowable range of 105 to 120 degrees F. Extra hygiene products and linens were available. Bathrooms had required bath mats and grab bars. Cleaning supplies stored under kitchen sink and in outside laundry room were inaccessible to residents in care. Knives and other items that could pose a risk were locked. Facility has at least two days of perishable and one week of non-perishable foods. Medications were centrally stored and locked. Fire extinguisher was last inspected May 2025. Smoke detectors and carbon monoxide detector located throughout the facility were tested and operational. Exit doors have auditory alert system and were functional at time of visit. Medications and medication records were reviewed. Required postings observed. LPA initiated file review at 9:30 am. Four staff files and four resident files were reviewed. Two out of four staff (S1 &S2) do not have required CPR/1st aid (technical violation issued), but all staff have their 20 hours annual training hours completed. Two out of four residents' (R1 & R2) care plans and medical assessments were not updated within the last 12 months. Continues on LIC809C... Continues from LIC809... Administrator Certificate is for Conchita Mejia-Chistiakoff #6001288740 Exp. 3/28/2023. Back up administrator Certificate for Administrator, Azeneth Gregoire, 6033722740, expires on 11/11/26 is current. LPA was provided with the following required documentation needed for the change of administrator: LIC 308 Designation of Facility responsibility, Administrator Resume (in small facilities if possible), LIC 500 Personnel Report (stating the numbers of hours when Administrator will be present at the facility), LIC 501 Personnel Record and Copy of Administrator Certificate (technical violation issued). LPA followed up with the Licensee and back up administrator/applicant regarding change of ownership update and LPA was informed that they are still in the process of submitting required documentation to the department. LPA provided eviction notice procedures and regulation for them to review and submit timely. Licensee will submit updates of the following documents by 2/20/26: Liability Insurance Certificate. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview conducted with back up administrator and a copy of this report was given.the state’s words, verbatim · CDSS document, Jan 26, 2026

The state marks this report as 6 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: -Staff mismanaging resident's medication.

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a complaint investigation and deliver findings regarding the above allegations and met with Orr Chistiakoff, Licensee. The Department received an allegation of staff mismanaging resident's medication. Per reporting party, resident (R1) was not provided with their noon medicine on days when they attended to adult day program, their medication has been mismanaged by the facility since R1 started attending to day program between December 20th and January 22nd, 2025, resulting in R1 have experienced multiple falls injuring the resident and decreased health condition. Based on records review, R1 was prescribed with Carbidopa 25/Levodopa 100mg tab, the prescription order states to take one and one-half tablets orally four times a day to assist with movement. The facility created a medication dosage chart for medication times to the following: AM - 8:30am, Noon - 12:30pm, Evening - 4:30pm and Bedtime - 8:30pm. Continue on LIC9099C... Unsubstantiated Continued from LIC9099... Based on interviews conducted with the Licensee and facility staff (S1) confirmed that there was a misunderstanding around the medication times determined by the facility, but it revealed that resident was indeed getting their medication four times per day as prescribed by their doctor. According to R1’s physician report dated 9/25/24, they are not able to store their own medications, which resulted in Licensee not handing them the medication to R1 to store them while they were attending to day program. Although, R1 was not dispensed with medications while they were attending to the day program, the time of the medication administration was changed, and medication was given to R1 when they arrived back from day program every day with medication times adjusted by the facility to meet doctor’s order of four times per day. The adjusted schedule reflects that R1 was taking Carbidopa at 8:30am, 3:30pm, 8:30pm and 11:30pm. A finding that the complaint allegation occurs of staff mismanaging resident's medication is unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.the state’s words, verbatim · CDSS document, Mar 19, 2025 · control 21-AS-20250211112554

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct an Annual Required Inspection and met with Licensee, Orr Chistiakoff. Annual fees are current. LPA/staff initiated a tour of the facility at 12:10 pm and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Water temperature in resident's bathroom measured at 115.2 and 112.3 degrees F which are within allowable range of 105 to 120 degrees F. Extra hygiene products and linens were available. Bathrooms had required bath mats and grab bars. Cleaning supplies stored under kitchen sink and in outside laundry room were inaccessible to residents in care. Knives and other items that could pose a risk were locked. Facility has at least two days of perishable and one week of non-perishable foods. Medications were centrally stored and locked. Fire extinguisher was last inspected May 2024. Smoke detectors and carbon monoxide detector located throughout the facility were tested and operational. Exit doors have auditory alert system and were functional at time of visit. Medications and medication records were reviewed. Required postings were observed. LPA initiated file review at 12:30 pm. Two staff files and six resident files were reviewed. Staff have required CPR/1st aid and 20 hours annual training hours completed. Residents care plans and medical assessments were updated within the last 12 months. Administrator Certificate for Administrator, Medardo A Galvez, 6058961740, expires on 4/12/25. Licensee will submit updates of the following documents by 1/17/25: Designation of Administrative Responsibility (LIC308), Personnel Report (LIC500) and Liability Insurance Certificate. No deficiencies cited during today's visit. Exit interview conducted with Licensee and a copy of this report was given.the state’s words, verbatim · CDSS document, Jan 7, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst, Cuadra, arrived unannounced to conduct an Annual Required Inspection and met with Licensee, Orr Chistiakoff. Required postings were observed. Annual fees are current. LPA/Licensee initiated a tour of the facility at 11:40 am and made the following observations: Facility was a comfortable temperature and passageways were free from obstructions. Resident rooms were furnished per regulation. Water temperature in resident's bathroom measured at 105.6 degrees F which are within allowable range of 105 to 120 degrees F. Extra hygiene products and linens were available. Bathrooms had required bath mats and grab bars. Cleaning supplies stored under kitchen sink and in outside laundry room were inaccessible to residents in care. Knives and other items that could pose a risk were locked. Facility has at least two days of perishable and one week of non-perishable foods. Medications were centrally stored and locked. Fire extinguisher was last inspected March, 2023. Smoke detectors and carbon monoxide detector located throughout the facility were tested and operational. Exit doors have auditory alert system and were functional at time of visit. Last Disaster drill was conducted on January 11, 2024. Medications and medication records were reviewed. LPA initiated file review at 12:00 pm. Two staff files and six resident files were reviewed. Staff have required CPR/1st aid and 20 hours annual training hours. Five out of six residents (R1, R2, R3, R4 & R5) care plans has not been updated within the last 12 months. One out of six residents (R3) needs current medical assessment. Administrator Certificate for Administrator, Medardo A Galvez, 6058961740, expires on 4/12/25. Licensee/Administrator to submit updates of the following documents by 2/7/24: Designation of Administrative Responsibility (LIC308), Personnel Report (LIC500) and Liability Insurance Certificate. Deficiencies cited from the California Code of Regulations, Title 22, Division 6 of California Regulation. Appeal rights given. Failure to correct the deficiency and/or repeat deficiencies within a 12 month period may result in civil penalties. Exit interview with Licensee and a copy of this report was given.the state’s words, verbatim · CDSS document, Jan 31, 2024