Facility Evaluation Report

Licensing Program Analyst (LPA) Angela Panushkina met with Tom Park, Executive Director, at 10:00am for a case management visit. The purpose of the case management visit is to confirm removal of staff.

At 10:00am LPA reviewed confirmation of removal form and requested LIC500 Personnel Report. Staff #1 is not indicated on the LIC500. LPA conducted a physical plant tour at 10:30am and no health and safety issues were observed . Staff #1 was initially hired as a MedTech. However, as of 04/25/22 the staff is no longer employed with the facility and has not returned.

Based on evidence obtained during today’s visit, the LPA has verified the individual is not present, employed or residing at the facility. LPA advised the Administrator to disassociate the individual from their roster. Contact Caregiver Background Check Bureau at 888-422-5669.

Exit interview conducted and copy of this report was provided to the Executive Director.