Facility Evaluation Report

Licensing Program Analyst (LPA) Hanna Gough made an unannounced visit for the purpose of conducting a Plan of Correction inspection for a deficiney issued on October 22, 2025, during the annual inspection. LPA was greeted and granted entry by staff. LPA met with Caregiver August Rebollar and discussed the purpose of the visit.

LPA observed letters for Resident #1 and Resident #2 stating they agree to discontinue use of their over the counter medications and supplements until physicians orders are obtained. LPA observed the medications have been removed from the residents medication boxes. LPA observed the Medication Administration Record to have the medications discontinued on October 22, 2025.

Based on today's observations the Plan of Correction has been fulfilled by the assigned Plan of Correction due date of October 23, 2025, thus clearing the Type A deficiency CCR 87465(c)(1).

An exit interview was conducted with August Rebollar and a copy of this report was left at the facility along with POC clearance letter.