Facility Evaluation Report

Licensing Program Analyst (LPA) Michael Tea made an unannounced visit for the purpose of conducting a Plan of Corrections Inspection for deficiencies issued on 09/09/2025 during the required annual inspection conducted by LPA Tea. LPA was greeted and granted entry by Licensee Victor Mckenzie. LPA discussed the purpose of the inspection with the administrator.

LPA Tea toured the facility to check the deficiencies that have been corrected with the administrator. There are fire alarms in each room and common areas. LPA checked the screen door leading to the backyard patio, facility fixed the screen door and now it opens and closes properly. LE Mckenzie showed proof that qualifying Administrator Garbrielle Tejasukmana is enrolled in an RCFE administrator course and is working on obtaining her administrator certificate. LE Mckenzie provided proof of completed CPR/First Aid certificate for caregivers. LPA confirmed that facility created updated centrally stored medication lists for each resident. LPA went to the kitchen to confirm emergency food and water supply for a 72-hour time period in the kitchen and pantry. LPA Tea will periodically check up on the facility to ensure compliancy.

Based on LPA Tea's observation on today's visit, the Plan of Corrections has been fulfilled by the assigned POC due date, thus clearing the Type B deficiencies CCR 87303(c), 87411(c)(1), 87465(h)(6) and HSC 1569.311, 1569.618(a), 1569.695(a)(2).

An exit interview was conducted with Licensee Victor Mckenzie and a copy of this report was provided to the facility