Facility Evaluation Report

On this day, May 15, 2025, at 11:30 am, Licensing Program Analyst (LPA) Delmundo arrived unannounced to continue the annual inspection that was started on May 14, 2025. LPA met with Milanette Escueta, administrator (ADM) and Kristine Reta, assistant administrator (AADM), and informed the reason for visit.

LPA reviewed 3 residents' file. Medications were checked and compared with doctor's orders and LIC622 Centrally Stored Medication and Destruction Records. Residents' P&I checked and compared with last recorded balance.

-at 11:53 am, resident (R2) does not have LIC601 Identification and Emergency Contact Information on file.

-at 12:30 pm, resident's (R1) quantities of 7 medications on the labels no do match the actual quantities received by facility.

-at 12:50 pm, resident's (R2) quantities 2 medications on the labels no do match the actual quantities received by facility.

-at 1:15 pm, resident's (R3) has half bed rails and hoyer lift but no doctor's orders on file.

Deficiencies are cited from Title 22 California Code of Regulations and listed on 809Ds. Failure to submit proof of corrections (POCs) by plan of corrections due dates and any repeat violation within 12 month period may result in civil penalty.

Deficiencies and plan and proof of corrections were discussed with the AADM. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided.