Facility Evaluation Report

Licensing Program Analyst (LPA) Leslie Ngo-Castaneda generated this report to address a deficiency observed during the course of a complaint investigation initiated today.

While reviewing client records, LPA observed Resident 1 (R1) to NOT have an physician's report and TB test. The rest of the residents has all completed proper paper work. LPA advised licensee that all residents taken in needs to have a complete paper work and TB test.

Report reviewed, signed, and delivered. Exit interview conducted, appeal rights issued, deficiency on LIC 809-D page.