Facility Evaluation Report

Licensing Program Analyst (LPA) Angela Panushkina met with Josefina Farardo Paras (S1) for a

case management. The purpose of the case management visit was to issue deficiencies observed during today's complaint investigation. Deficiencies observed have nothing to do with complaint.

At 10:02 am LPA did not observe transfer request on file for Staff (S1).

At 10:15 am LPA conducted a tour of the facility and interviewed resident who were able to communicate.

At 10:20 am LPA observed a hospice resident in room #2. Facility does not have an approval for hospice.

Following citations issued for the identified deficiencies pursuant to Title 22 Regulations on LIC809D.

Exit interview conducted, appeal rights discussed and a copy of this report provided to the Administrator. `