Facility Evaluation Report

An informal conference was conducted on Wednesday September 4, 2024, via Microsoft Teams. The purpose of this informal conference meeting is to discuss deficiencies discovered during a complaint investigation which began in May 2024. Present in the meeting is Licensing Program Manager (LPM) Maribeth Senty, Licensing Program Analyst (LPA) Melissa Parks, Jona Diamond, ALTA Regional Service Coordinator, BJ Thompson, ALTA Regional Client Services Manager, and Licensee Howard Huntsberry. The informal conference process was explained during this meeting.

The facility has been cited 3 times in the last year. The facility was cited under the following regulations: personnel requirements, fire clearance, and reporting requirements. The facility was cited for two Type A citations, and one Type B citations.

The licensee was told that this Informal conference is a part of the Administrative Action process and that further citations may result in an elevation to a formal non-compliance conference, which could lead to a referral to the Department's legal division for possible revocation of license.

Issues discussed during the meeting were:

· Plan for nonpermitted staff office/room