Facility Evaluation Report

On 10/03/2022 at 10:03am, Licensing Program Analyst (LPA) conducted an unannounced case management visit. LPA was greeted and granted entry by Facility Staff (FS) Eppieabien Mendoza and completed the Coronavirus 2019 (COVID-19) screening procedure. FS Eppieabien Mendoza notified Administrator (Admin) Analouise Igisaiar via a telephone a call and arrived at the facility around 10:10am. LPA met with Admin and stated the purpose of the visit. LPA requested and reviewed records for Client #1 (C1) to Client # (C6) and obtained copies of the following pertinent records per client: IPP and Admission Agreement. Time sheets for Staff 1 (S1) to Staff 9 (S9) were requested indicating the days and hours worked during the last 3 months. In addition, the Purchase of Service (POS) for C3 and C5 were requested. Admin requested the information to the facility's HR representative, but was unable to provide the information during the visit. Due to time constraints, Admin agreed to provide the aforementioned staff documents and client POS to LPA by COB Thursday, October 6, 2022.

An exit interview was conducted, and a copy of this report along with the 811s were provided to Administrator Analouise Igisaiar.