Facility Evaluation Report

On December 05, 2024 at 8:10 am Licensing Program Analyst (LPA) Zina Brown conducted an unannounced health and safety check to follow up on a incident that occurred on November 27, 2024.

During today visit we met with Maria Bravo (Administrator) and explained the purpose of the visit.

During today's visit, LPA conducted interviews with staff and clients. LPA also reviewed and collected the following:

LIC 601: Identification and Emergency Information (Resident #1 - Resident #2)

LIC 602: Physician's Report for Community Care Facilities (Resident #1 - Resident #2)

LIC 625: Appraisal/Needs and Services Plan (Resident #1 - Resident #2)

Medication list for (Resident #1 & Resident #2)

Reviewed and received video surveillance footage of the incident that occurred on 11/27/2024

Due to insufficient information available at this time a further investigation is needed.

A exit interview was conducted with Maria Bravo (Administrator), and a copy of this report was provided.