Facility Evaluation Report

On 1/29/2025 at 10:30 AM, Licensing Program Analysts (LPAs) James Sampair and Jill Clancy-Czuleger arrived unannounced to conduct a Plan of Correction (POC) visit. Upon arrival, the LPAs stated the purpose of the visit to Licensee Ericka Tillis.

On 01/13/2025, LPA Sampair conducted a Case Management visit during which 4 deficiencies were cited. 1 deficiency was cleared during the visit. 3 of the deficiencies were not cleared during the visit: resident records missing, no emergency/disaster drill conducted, and the hot water temperature was measured at 133.7 degrees Fahrenheit.

Civil Penalties for deficiencies not cleared during visit:

Due 1/14/202 5 for 87303(e)(2) 16 x $100 per day = $1,600

Due 1/14/2025 for 87506(a) 16 x $100 per day = $1,600

Due 1/27/2025 for 1569.695(c) 2 x $100 per day = $200

Civil Penalties in the total amount of $3,400 have been assessed today for failure to meet POC due dates for the deficiencies above. Facility is subject to ongoing daily civil penalties until proof of corrected deficiencies have been sent to CCL.

Exit interview conducted. A copy of this report, appeal rights, and LIC 421FCs provided.