Facility Evaluation Report

Licensing Program Analyst (LPA) Erik Zaragoza conducted a case management visit following the completion of a complaint visit which was conducted on 11/20/2023 and is related to the complaint investigation control #28-AS-20220121155956. LPA initially met with Clarissa Basto, Medication Supervisor for the facility, and explained the purpose of the visit. Administrator Ruby Garcia arrived shortly thereafter.

During the complaint visit, LPA toured room #128 of the facility along with its adjacent bathroom, and LPA observed that the condition of the room was poor. LPA observed that the ceiling fan located in the center of the room has an excessive amount of fan mold and dust on its blades and also surrounding the ceiling itself. Additionally, LPA observed that the windows of the bedroom were similarly covered in dust, and also found that the window in the bedroom cannot close and is therefore left slightly open and ajar. Furthermore LPA observed that the curtain covering the window in the shower room does contain tears in it as well. Pictures were taken of the state of the window, the ceiling fan, and the curtain that covers the bathroom's window curtain as well.

The deficiency is noted on LIC 809D per Title 22 Regulations.

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