Facility Evaluation Report

On this day, September 25, 2025, at 10:30 am, Licensing Program Analyst (LPA) Delmundo arrived unannounced to continue the annual inspection that was started on September 4, 2025. LPA met with George Vidican, licensee-administrator, and informed the reason for visit.

LPA reviewed 1 staff and 1 resident files. Medications were checked. Resident's P&I was also checked and compared with last recorded balance.

R1's 7 medications filled on 9/11/25 were not recorded on LIC622 Centrally Stored Medication and Destruction Record.

R1's Vitamin filled on 9/18/25 was also not recorded on LIC622.

LPA received copy of proof of Surety Bond coverage on this day. Administrator has not submitted the following which LPA requested to submit by September 18, 2025:

1. LIC308 Designation of Facility Responsibility

3. LIC610D Emergency Disaster Plan (9 pages)