Facility Evaluation Report

Licensing Program Analysts (LPAs) Kimberly Lyman and Celine DePero made an unannounced visit to the facility for the purpose of a Plan of Correction (POC) visit, based upon the deficiencies cited in LIC form 809D on 06/28/2022. LPAs were greeted and granted entry into the facility by Administrator Esther Rey and explained the reason for the visit.

*Deficiency cited under Title 22 Regulation 87465(h)(2) pertaining to Centrally Stored Medications has been cleared. Licensee secured noted items. Licensee has complied with the terms of the POC.

.*Deficiency cited under Title 22 Regulation 87705(f)(2) pertaining to Inaccessible Items (Care of Persons with Dementia) has NOT been cleared. Licensee did not secure items. LPAs observed unsecured vitamins, Windex, and disinfectant spray. Licensee has NOT complied with the terms of the POC. CIVIL PENALTY ISSUED.

Administrator to provide an updated LIC 500 to LPA by 07/14/2022.

Exit interview conducted and a copy of this report was left at the facility.