Facility Evaluation Report

On 06/17/2026 at 12:50 PM, Licensing Program Analyst (LPA) Patricia Manalo conducted a case management legal non-compliance visit and met with General Manager, Ryan Turner Health Services Director, Leslie Ibo. LPA explained to Turner and Ibo the purpose of the visit.

This case management visit is conducted as follow up on the facility's compliance plan as a result of the Non-Compliance Conference (NCC) conducted on March 25, 2025.

During the visit, LPA reviewed incident reports regarding the water leak in the dining room that occured on 06/03/2026 and the power outage on 06/09/2026 which resulted in R1 stuck in the elevator. Interview with R1 confirmed that R1 was stuck in the elevator, however, the facility staff contacted 911 right away. Both incidents were reported to the Department on a timely manner. LPA conducted a tour of the facility including Memory Care Units and the Dining room. LPA observed the elevator in operational and a portion of the dining area where the leak took place is blocked off from the residents. LPA will request for an update once the repair is concluded in the dining room.

LPA reviewed R2's incident report that indicated falls that occured on 06/01/2026 and 06/04/2026. During both incidents, 911 and R2's responsible party was contacted. A review of R2's doctor's order indicated that due to the reoccurring falls, one of R2's medications is discontinued to help minimize the falls. LPA and Ibo discussed the facility's care plan will be for R2

No deficiencies cited. Exit interview was conducted and a copy of this report was provided via email.