Facility Evaluation Report

Licensing Program Analyst (LPA) Christian Gutierrez conducted an annual continuation visit. Upon arriving at the facility, LPA met with caregiver Maria Campos and explained reason for visit. Administrator Hiransha Keerthisinghe and Assistant Administrator KM Dhammike Keerthisinghe arrived shortly after.

On 04/27/26 LPA conducted an initial visit. During today's visit LPA Gutierrez reviewed the following CARE inspection tool domains: Staffing, Personnel Records/Staff Training, resident rights, resident records, health related services, and incidental medical services.

Four (4) staff files were reviewed and included criminal clearance record, and health screening with TB. The required 20 hours of annual training was not completed. Five (5) of the six (6) resident files reviewed included physician reports and appraisal needs and service plan. R5 did not have updated physicians report LIC 602. Two (2) residents R4 and R5 were missing statements for shared room with a hospice resident. The medications are centrally stored and locked in a cabinet in living room. LPA reviewed medications for residents, and they are being administered as prescribed by the physician.

Deficiencies have been noted on LIC 809D under Title 22 Regulations. Exit interview was conducted and a copy of this report, LIC 809D and appeal rights were provided to Hiransha Keerthisinghe.