Facility Evaluation Report

Licensing Program Analyst (LPA) Delmundo arrived unannounced to conduct a Proof of Correction (POC) visit. LPA met with George Vidican, licensee-administrator, and informed the reason for visit.

On 9/14/23, LPA conducted an annual inspection and issued the following citations with POC to be submitted by 10/05/23:

1. Section # 80087(a) - pictures to be submitted showing living room and carpet cleaned, chipped linoleum replaced, and yard cleaned.

2. Section # 85068.3(a) - POC to submit copies of LIC625 Appraisal/Needs and Services Plan

3. Sectio n # 80070(a) - POC to submit self-certification that the LIC622 Centrally Stored Medication and Destruction Records are completed.

Licensee submitted the LIC9098 Proof Correction form but without the POCs.

On this day, 10/18/23, LPA toured the facility and checked residents records and observed the following:

1. Section # 80087(a) - the carpet flooring cleaned and chipped linoleum flooring replaced; backyard cleaned; however, the living room is partially cleared.

2. Section # 85068.3(a) - records showed LIC625 updated.

3. Section # 80070(a) - records showed LIC622 updated.