Facility Evaluation Report

At approximately 10:15 AM, Licensing Program Analyst (LPA) Julie Florio arrived unannounced to conduct a Case Management - Annual Continuation inspection and met with Viridiana Agapoff, Administrator. Facility is a Residential Care Facility for the Elderly with eight (8) residents in care. Three (3) residents are currently on Hospice and facility has a Hospice waiver for four (4).

At approximately 11:00 AM, LPA conducted file review. Four (4) staff and five (5) residents' files were reviewed and LPA observed the following: All files reviewed contained the required documents per Title 22 regulations, including Hospice care plans for those residents receiving Hospice services. LPA discussed with Administrator the requirement ensuring all resident and staff records are current and present in the files and Administrator agreed to ensure the facility is operating within compliance at all times.

At approximately 2:45 PM, LPA reviewed medications and medication records which are maintained and stored in compliance with regulation.

No deficiencies were cited during today's inspection.

Exit interview conducted with Administrator whose signature on form confirms receipt.