Facility Evaluation Report

Licensing Program Analyst (LPA) Bennette Pena generated this Case Management - Deficiencies report in conjunction with complaint control # 28-AS-20220808143000 pertaining to observations made during the subsequent complaint visit by LPA Pena on 10/19/2022. The purpose of the report was explained to Administrator Flordeliza Sasada.

LPA observed that the facility did not have reappraisal to note significant changes and update R1’s declining health issues and, the facility did not have R1’ s current physician report on file.

Based on information gathered, the deficiencies are issued on the LIC809D. An exit interview was conducted, and a copy of the report and appeal rights were issued to Administrator, Flordeliza Sasada.