Facility Evaluation Report

At 11:50 a.m. on this day, April 3, 2024, Licensing Program Analyst (LPA) Delmundo arrived unannounced to continue the annual inspection that was started on March 22, 2024. LPA met with staff, Jose 'Jay' Fernandez and Milagros 'Mel' Fernandez, and informed the reason for visit. LPA called and spoke over the phone with Victoria Canovas, administrator, who arrived at around 12:30 p.m.

LPA interviewed 2 residents and 2 staff, and reviewed 4 residents and 3 staff files. Medications were inspected and compared with doctor's orders and medications in facility's hand. Residents' P&I were checked and compared with last recorded balance.

-at 1:00 p.m., Victoria Canovas' administrator's certificate on file expired 4/06/23, LPA checked the Community Care Licensing website for Active and Pending Lists, and Canovas is not on the lists.

-at 2:00 p.m., residents' (R1 and R2) P&Is have no LIC405 Record of Client's/Resident's Safeguarded Cash Resources on file.

-at 3:35 p.m., one of resident's (R3) medications has double entries on LIC622 Centrally Stored Medication and Destruction Record. R3's medicated shampoo has no doctor's order on file.

-at 4:15 p.m., resident's R2, R3 and R4's LIC625 Appraisal/Needs and Services Plan were over 4 years old.

Deficiencies, and plan and proof of corrections were discussed with the administrator. Failure to submit proof of corrections by plan of correction due dates, and any repeat violations within 12 month period may result in civil penalties.

Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form, and copy of this report provided.