Facility Evaluation Report

Licensing Program Analyst (LPA) Cuadra conducted an unannounced required annual inspection of this facility and case management to cite deficiencies discovered during a complaint investigation

# 21-AS-20260126092155 met with facility Administrator Kathleen Devera. Annual fees current.

LPA learned through records review and interviews with Administrator while investigating complaint # 21-AS-20260126092155 that the facility has failed to follow up when resident (R1) reported to staff (S1, S2 & S3) on 1/19/26 at 2:09pm an alleged “abuse” has occurred. According to the Administrator, R1 has a history of been aggressive to staff, so it was presum ed as another unfounded incident. On 12/12/25 there was another incident involving another resident (R2) where it was reported to facility management that staff (S4) was no longer welcome to care for R2 due to their incompetency when providing care and been always in a rush, getting defensive and other complaints that other staff raised about them, which resulted in management conducted an internal investigation and provided a written warning. LPA reviewed incident reports submitted to the Department and there were no incident reports regarding any of these reports.

LPA/Administrator toured the building and grounds: The main building is two stories and currently there are eleven residents residing downstairs and four residents upstairs. Second building is single story and currently there are three residents. There were two staff and housekeeper staff present in the second building providing care and supervision to residents in care. Continue on LIC809C...