Facility Evaluation Report

On 07/11/25 Licensing Program Analyst (LPA) Mario Leon conducted a case management, related to lack of an updated physician's report for a resident in care, resident two (R2). LPA was met by staff two, Kathleen Mantes - Caregiver (S2) and the reason for this case management report has been provided.

On 07/10/25 Licensing Program Analyst (LPA) conducted an initial, unannounced, complaint visit. During the visit, LPA requested a copy of R2's physician report (LIC624a) yet it was not provided. On 07/11/25 LPA returned to conduct a subsequent, unannounced, complaint visit. LPA requested R2's LIC624a. Record reviews revealed that R2's LIC624a shows a Physician has diagnosed (Dx) R2 as having "Dementia" and that this report is not current (dated: 01/23/24), please see LIC809-D. This indicates that this facility needs to obtain an updated LIC624a for R2. LPA was informed that R2's family member(s) have been contacted on 06/24/25, and on 07/10/25, for an updated LIC624a. Further record reviews revealed that R2's family member(s) have been made aware (dated: 06/24/25 & 07/10/25), yet this facility is still without an updated physician's report for R2.

During today's visit, one (1) deficiency has been cited, please see LIC809-D.

An exit interview was held with staff two, Kathleen Mantes - Caregiver (S2) and a copy of this deficiency, facilities' appeal rights and this report have been provided to Kathleen Mantes - Caregiver (S2).