Facility Evaluation Report

On 01/31/25 at 2:50PM, Licensing Program Analyst (LPA) Daisy Panlilio conducted an unannounced case management visit to confirm that no residents are living at the home for facility closure. LPA explained the purpose of the visit with administrator (ADM).

At 3PM, LPA toured the facility with ADM and observed no residents living at the facility. ADM stated that last remaining resident passed away on 03/10/24. LPA observed all COVID-19 signages, Provider Information notices, Emergency/Disaster plans, Complaint

poster, Ombudsman poster and Personal rights have been removed from common areas/bathrooms.

During visit, ADM surrendered their state license to LPA. ADM stated that they decided to close the facility because they wanted to have more time with family.

Exit interview conducted and a copy of this report provided.

Attached is facility closure email sent by administrator on 01/31/25: