Facility Evaluation Report

Licensing Program Analysts (LPAs) M. Flores and S. Doucette arrived at the facility unannounced to continue the completion of the annual inspection. LPAs were granted entry by caregiver, Analyn Ramos and explain the purpose of the visit.

During the visit a file review was conducted for residents and staff files, refer to 809D for deficiencies.

An exit interview was conducted, and a copy of this report was provided to AD1 whose signature confirms receipt.

LPA requested the following updated forms faxed to CCLD by 9/12/23: Designation of Facility Responsibility (LIC308), Administrative Organization (LIC309), Personnel Report (LIC 500), Proof of current Liability Coverage .