Facility Evaluation Report

Licensing Program Analyst (LPA) Mariana Agban conducted an unannounced continuation of the annual visit. The LPA met with Administrator Ruslan Levin and explained the reason for the visit. During today's visit, the LPA reviewed files for three (3) residents to ensure compliance with licensing forms. LPA observed that R3 has an incomplete Admission Agreement and lacks appraisal needs and services (LIC 603A). Additionally, R4 and R5 have no updated physician report (LIC 602). LPA also conducted a review of staff records to ensure that forms and training are current and comply with licensing requirements. LPA noted that S2 and S3 are missing the LIC 503 forms. The administrator advised that all required forms will be emailed to LPA Agban promptly. Finally, LPA conducted a review of medication records. The LPA found that medications and medication records were inconsistent.

Exit interview conducted, citations issued, appeal rights given and copy of this report delivered.