Facility Evaluation Report

On April 22, 2025, Licensing Program Analysts (LPAs) Edward Kim and Jessica Cho conducted an unannounced Case Management Visit to follow-up on an incident report received from the facility. LPAs Kim and Cho met with Executive Director (ED) Mandy Taylor and explained the purpose of the visit.

During today’s visit, LPAs obtained information pertaining to the incident which occurred on January 29, 2025, involving Resident #1 (R1) and Staff (#1). LPAs obtained the Staff Roster, Resident Roster, S1’s records, and R1’s records which includes the Physician’s Report, Admissions Agreement, Emergency Information, and other pertinent documents. During the visit, LPA Kim interviewed two staff members and one witness.

A deficiency was observed during this visit as facility did not maintain R1’s Physician’s Report that was signed and dated.

An exit interview was conducted, and a copy of this report along with the LIC809-D, LIC811, and the appeal rights were provided to Executive Director Mandy Taylor.