Facility Evaluation Report

On 08/08/22 Licensing Program Analyst (LPA) Ernand Dabuet conducted a case management - annual continuation visit at this facility. Upon arrival at the facility, LPA was greeted by assistant administrator Anchie Reyes and conducted a risk assessment. Based on the assessment, the facility is clear of COVID-19 infection.

During the inspection, smoke detectors and carbon were tested and found in working condition. The facility has a working lineline phone. A review of Medication Administration Record (MARs) revealed to be maintained accurate and in order.

LPA reviewed service records for resident #2 (R2) who was admitted on 07/05/22 under hospice care and failed to notify CCL within five days of admittance according to Hospice Care Waiver Regulation 87632. The administrator is being cited according to Administrator's Qualifications Regulations 87405 resulting in multiple deficiencies cited.

California Code of Regulations (Title 22, Division 6, Chapter 8), deficiencies were observed, and citations were issued (ref. LIC 9099-D).

An exit interview was conducted and a copy of the Evaluation Report and Appeal Rights were provided to Anchie Reyes.