Facility Evaluation Report

Licensing Program Analyst (LPA) Talwinder Bains and Licensing Program manager (LPM) Laura Munoz arrived at the facility unannounced on 10/19/22 and met with administrator Mirel Ivascu , Prior to the visit , LPA and LPM completed required COVID-19 testing protocols and the daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA and LPM wore the following Personal Protective Equipment (PPE) during today's visit-surgical masks.

LPA and LPM were screened by facility staff upon entry.

On 08/02/2022, the department conducted a complaint investigation at which time the department had requested R1s admission agreement and other related documents and facility needed to submit those documents by 08/07/22. As of this date, the facility did not submit requested documentation therefore, deficiency Type-B is being cited per Title 22 ,CCR, Regulation -87755(c).

Appeal rights provided, copy of the report left at facility. Exit Interview conducted.