Facility Evaluation Report

Licensing Program Analyst (LPA) Fernandes-Goes arrived unannounced with the purpose of closing a complaint investigation. LPA was welcome by staff, Michelle Tootle - Manager of Program Operations was contacted on the phone. LPA met with Michelle Meeks - staff. Following item were learned/observed visits:

During visit on 12/17/2021, LPA learned that Duna Joson will no longer be the administrator at this facility per Michelle Tootle - Manager of Program Operations. Facility has submitted a new LIC 500 - Personnel Report. Department is requesting information for new facility administrator. The following is to be submitted to the Department ASAP:

LIC 308 Designation of Facility responsibility (designation of who is the administrator)

Administrator Resume (in small facilities if possible)

LIC 610 Emergency Disaster Plan for Residential Care Facilities for the Elderly

LIC 503 Health Screening Report - personnel (keep on facility staff file to be reviewed)

TB test that shows "negative" (keep on facility staff file to be reviewed)

LIC 9182 Criminal Record Exemption Transfer Request

Copy of Board of Directors' Resolution meeting minutes signed (required for all corporations)

Detailed employment/Education history with Diploma Certificate