Facility Evaluation Report

On 10/14/24, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to conduct a Health and Safety inspection based on a death report received 10/14/24. LPA met with Administrator, stated the purpose and was allowed entry into the facility.

LPA toured the facility and observed 3 residents in care at the time of visit, 2 staff and Administrator were present. LPA observed a 7-day supply of non perishables and 2 day supply of perishables. Facility inside temperature measured at 74 degrees.

LPA requested Resident R1's file and obtained the following information: Admission Agreement, vendor referral form, Hospital discharge papers, staff schedule for October, Personnel report LIC 500, and facility progress notes. Administrator was unable to provide pre-admission appraisal (LIC603a), physician's report (LIC602a) or needs and service appraisal (LIC625) or reassessment/functional capabilities assessment (LIC 9172).

Exit interview conducted. LPA will review documentation received and return at a later date to issue deficiencies. No deficiencies cited on today's visit.