Facility Evaluation Report

In conjunction with control number 31-AS-20250428084431 complaint visit, Licensing Program Analyst (LPA) Evelin Rios did an unannounced CASE MANAGEMENT - Deficiencies visit. A case management report is being issued today in conjunction to the complaint visit report for observed deficiencies not related to complaint. LPA met with Rocela Molina - Lead Caregiver.

Interview with staff revealed there was a staff #1 (S1) who provided care to residents in the facility. Review of S1's record and Guardian Background Check revealed S1 is not fingerprinted cleared.

Review of five (05) out of (05) resident records revealed resident #4 (R4) had after visit paperwork from emergency room visits. According to the Lead Caregiver, R4 had medical emergencies that required the facility to contact 911 on separate occasions. Review of Community Care Licensing Division (CCLD) records revealed the facility had not submitted Unusual Incident/Injury Report to CCLD. Review of R1's record revealed the facility submitted Unusual Incident/Injury Reports from 02/05/2025 to 04/07/2025 to Long Term Care Ombudsman about R1's ongoing interactions involving certain facility staff. Review of Community Care Licensing Division (CCLD) records revealed the facility had not submitted Unusual/Injury Incident Reports to CCLD.

Deficiencies observed and cited (Refer to LIC 809-D). Exit Interview Conducted / Appeal Rights Discussed / A Copy of Report Issued.