Facility Evaluation Report

At approximately 9:00AM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Case Management - Deficiencies Visit and met with the front desk receptionist. Resident Relations Director, Arlene Samonte (AS), arrived later during visit at approximately 9:15AM. Executive Director/Administrator, Ricardo Romero, arrived later during visit at approximately 10:00AM. The purpose of the visit was to follow up on self-reported incidents that were submitted to Community Care Licensing (CCL).

LPA conducted a walkthrough with Resident Relations Director and Executive Director/Administrator.

LPA and Executive Director discussed the following:

LPA reviewed the following reports with Executive Director:

Incident Report 1: CCL received an incident report on 10/4/2022. Report states that on 9/26/2022, Resident 1 (R1) was found on the floor. Resident was observed to be unable to verbalize the event and only say their name. Facility called Emergency Personnel to evaluate and R1 was sent to the hospital. Facility made all appropriate notifications per regulation.

LPA and Executive Director discussed R1. As of 2/3/2023, R1 has since moved out of the facility due to changing care needs.