Facility Evaluation Report

Licensing Program Analyst (LPA) Mary Flores conducted an unannounced Case Management -Annual Continuation visit at the facility to continue annual visit initiated on 9/19/25 using the CARE tools. LPA met with Kevin Taliafero and explained the reason for the visit.

The following domains were completed during this visit:

Personnel Records/Staff Training : LPA reviewed 10 staff files. Files were available for review, Files include; TB clearance, health screening, background clearance, personnel record, and training. Five staff were interviewed.

Incidental Medical and Dental: Facility provides assistance with medical/dental arrangements and with medication assistance. Medications were observed stored in medication carts in medication room and in the dementia unit. LPA reviewed medication for 10 residents. A log for PRN/Narcotics medication was observed. Resident #6(R6) had clotrimazole 1% cream out of original container without pharmacy label.

Resident Records/Incident Reports: LPA reviewed 10 residents files, each contained admission agreement, medical assessment, TB clearance, pre-appraisal. Appraisal for R4 was last done on 6/26/23, Resident #5(R5) was last done on 4/16/24, R6 was last done in 8/14/23, Resident #9(R9) pre-appraisal was done in 3/3/19. Five residents were interviewed.

Residents with Special Health Needs Facilit y: Facility is serving 5 residents on hospice. Two hospices plans were reviewed. Facility does not have bodies of water. Dementia unit residents do not have access to knives/sharps, chemicals or medications. A delay egress system was observed and tested in the dementia unit.

Deficiencies noted on LIC 809D per Title 22 Regulations.

Exit interview was conducted and a copy of this report, LIC 809D, and appeal rights were provided.