Facility Evaluation Report

Licensing Program Analyst (LPA) Evelin Rios conducted unannounced Case Management - Deficiencies visit to this facility in conjunction with a complaint control #31-AS-20240125095336. LPA met with the Administrator and explained the reason for the visit.

While conducting the physical plant tour administrator notified LPA resident #3 (R3) had passed away and that is why the room was vacant. A Death Report was not submitted to the department. According to administrator they have been busy and forgot to send it to the department.

While reviewing resident records, resident#2 (R2) records revealed the administrator had admitted the resident without a an written appraisal. According to administrator they are currently working on it.

Administrator did not have current Administrator certificate to show LPA during time of visit. Administrator will send a copy of certificate to LPA by 02/02/24.

Deficiencies cited (refer to LIC 809D). Exit interview conducted, appeal rights and copy of report signed and delivered.