Facility Evaluation Report

Licensing Program Analyst (LPA) Elena Mallett conducted an unannounced POC visit to clear a deficiency cited on a 12/19/25 Case Management visit. LPA Mallett was met by Staff in Charge, Adrianne Gray and the purpose of the visit was discussed. Staff in charge stated Licensee Percy Olidan has been in the Phillipines on a personal matter since 12/11/25 early in the AM. Staff will assist with visit and sign the Licensing report.

(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers.

Based on observation, the licensee did not comply with the section cited above in 3 out of 3 residents medication supply. The medication for 3 out of 3 residents was prepared in advanced and stored in pillboxes rather than in the original containers. A plan on training staff for not utilizing pillboxes to dispense medication was not received by Licensing.

The pills were observed to be in the pillboxes during today's visit. Civil penalties issued on Today's visit in the amount of $400 for the period of 12/20/25-12/23/25 and will be ongoing until the deficiency is corrected.

An exit interview was conducted with Staff Adrianne Gray and the failure to correct the deficiency cited per Title 22 Regulations was discussed. The Civil Penalties assessed today were discussed. A copy of Appeal Rights was provided along with this Licensing Report. A copy of this Licensing Report will be emailed to Licensee Percy Olidan.