Facility Evaluation Report

Licensing Program Analyst (LPA) Yolanda Delgado arrived unannounced to conduct an annual inspection. Upon arrival LPA was greeted by facility staff and granted entry by Juanita Jackson. LPA began inspection with introduction, visit purpose and provided the facility Health & Wellness Director with LPA identification and business card. Theresa Ward arrived during the inspection.

Resident record review began- Five (5) records were reviewed. LPA reviewed for admission agreement, medical assessment and TB test results, consent forms, identification and emergency information, appraisal needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. This facility is meeting documentation requirements.

Due to time constraints, Annual will need to be completed at a different day.

Based on the information received during this visit today, there are no deficiency is being cited per Title 22, Division 6 of The California Code of Regulations.

This report was reviewed with Theresa Ward and a copy provided to the facility representative at the time of the exit interview.