Facility Evaluation Report

Licensing Program Analyst (LPA) Ashley Calderon, made a unannounced annual continuation case management visit. LPA met with interm-Administrator Claudia Sanchez and discussed the purpose of today's visit.The facility is licensed to serve: Elderly residents ages 60 and over. Approved for (48) ambulatory residents and (32) non-ambulatory residents. (7) non-ambulatory can be bedridden. Bedroom # B1,A2,4,5,8,9,12 are cleared for bedridden residents.

During today's visit LPA used the CARE Inspection Tool to continue the 1 year required annual inspection, LPA reviewed medication for (3) residents and reviewed centralized medication log. No deficiency noted for medication review.

LPA Calderon did staff file review for, a total of (5) files, five files were reviewed. LPA checked for clearance, personnel records, health screening, training and first aid/ cpr certification. During file record review the following was observed and cited:

1) Personnel records- for Staff # S3 did not contain a job application nor an LIC 501 personnel record and no physician health screening / tb report LIC 503 - Interm-Admin. Claudia Sanchez assisted LPA Calderon in locating documentation's and documentation's were not in S3 file. (2) Deficiency cited.

2) No clearance record for Staff #1(S1), LPA Calderon called LPM Fierros and Licensing Support Staff to verify clearance of S1, LIS did not contain records of S1 on the system, Facility Interm-Admin. Claudia Sanchez was unable to get record of S1 clearance status. Deficiency and Civil Penalty cited.

LPA was will return on a later time to complete annual inspection.

LPA will sent reports 809, (2) 809-D pages, Civil Rights, and Appeal Rights to Interm-Administrator Claudia Sanchez via email. Due to printer issues.