STATE OF CALIFORNIA - HEALTH AND HUI-IAN SERVICES AGENCY . CALIFORNIA DEPARTMENT OF SOCIAL EERVIGES
COMHUNITY CARE UCENSING DMSIHN

FACILITY EVALUATION REPORT (Cont) cho Regional Office, woo CORPORATE on ma

MONTERY PARK. CA 91754
NAME: COURT YARD ESTATES FACILITY NUMBER: 198205250
VISIT DATE: 02l20l2019
NARRATIVE

The licensing investigation determined that Licensee?s failure to provide care and supervision
caused R1 to suffer serious bodily injury. On January 14, 2019, the Licensee was informed that a
civil penalty maybe assessed pursuant to the Health Safety Code section 1569.496).

 

The Department has concluded its investigation and analysis regarding the care afforded to R1 by
the LicenSee and has determined that a Civil Penalty per Health and Safety Code 1569.49(f) for
$10,000 is warranted for serious bodily injury. The Welfare and Institution Code? 15610.67 defines
serious bodlty injury as "an injury involving extreme physical pain, substantial risk of death, or
protracted loss or impairment of function of a bodily member, organ, or of mental faculty, or
requiring medical intervention, including, but not limited to hospitalization, surgery, or physical
rehabilitation 

Appeal rights were provided.




 

 

3UP NAME: Myriam Luga TELEPHONE: (323] 980-4932
LICENSING EVALUATOR NAME: Cheraki Davis TELEPHONE: (323) 980-4935
LICENSING EVALUATOR SIGNATURE:

- DATE: 02l20i2019


acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

 

 

DATE: 029012019

 

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