Facility Evaluation Report

Licensing Program Analyst (LPA) Michael Tea made an unannounced visit for the purpose of conducting a health and safety check. LPA was greeted and granted entry by staff. LPA met with Executive Director (ED) Mike Marion and discussed the purpose of the visit.

During today's visit LPA followed up on a death report for Resident 1 (R1) dated August 20, 2025, received by CCLD on August 22, 2025. LPA toured the facility and conducted a health and safety check on all residents in care. LPA observed no health and safety issues. LPA obtained pertinent documentation such as Resident Face sheet, Identification and Emergency Information, Medical Assessment, Preplacement Appraisal, Release of Medical Consent, POLST, Facility Resident Assessment, Needs and Service Plans, R1's Narrative Charting Notes and MAR. LPA filled out the questionable death report.

An exit interview was conducted with ED Marion and a copy of this report along with a list of confidential names was left with the facility.