Facility Evaluation Report

Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced visit to Lake Forest Country Home #2 to conduct a case management (CM) visit. The purpose of this CM visit was to gather facility files in regards to the incident reported by facility administrator (AD) Carmen Rivas.

LPA De Perio arrived at facility at 10:14 AM and was granted entry by staff on duty. LPA observed a total of 4 residents in care. LPA toured the interior portions of the facility with staff and resident. AD arrived at 10:33 AM and provided LPA copies of the following documents:

SOC 341 (completed and provided LPA hard copy)

Statement Acknowledging Requirement to Report Suspected Abuse of Dependent Adults and Elders

Copy of written check provided by resident