Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Lyman 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 07/09/2026. LPA was greeted and granted entry into the facility and explained the reason for the visit. LPA Lyman spoke with Administrator Mel Amante via telephone.

*Deficiency cited under Title 22 Regulation 87309(a) pertaining to Storage Spaces has NOT been cleared. During today's visit, LPA observed the unsecured the cleaning supplies noted in the LIC 809 were still unsecured. Licensee has NOT complied with the terms of the POC. CIVIL PENALTY ASSESSED

*Deficiency cited under Title 22 Regulation 87465(h)(2) pertaining to Centrally Stored Medications has NOT been cleared. During today's visit, medications are unsecured in an unlocked cabinet. Licensee has NOT complied with the POC. CIVIL PENALTY ASSESSED.

*Deficiency cited under Title 22 Regulation 87203 pertaining to Fire Safety has been cleared. During today's visit, the exit gate and the exit door in resident bedroom is not blocked. Licensee has complied with the POC.

*Deficiency cited under Title 22 Regulation 87465(h)(5) pertaining to Pre-Poured Medication has been cleared. During today's visit, pre-pouring has been discontinued. Licensee has complied with the POC.

*Deficiency cited under Title 22 Regulation 87465(c)(3) pertaining to PRN Documentation has been cleared. During today's visit, facility is documenting PRN medication administration. Licensee has complied with the POC