Facility Evaluation Report

Licensing Program Analyst (LPA) Pang Lee arrived unannounced at the facility on 02/12/2026 to conduct a case management visit. LPA Lee met with care staff, Arianne Dagohoy, and explained the purpose of the visit. Care staff Dagohoy reported that Administrator Michael Jankowski has been out of state on vacation since 02/07/2026 and is expected to return at the end of the month.

The purpose of the visit was to follow up on deficiencies identified during complaint investigation control number 27-AS-20250825160003. On 01/30/2026, a medication review was conducted for five (5) residents by examining the medications stored in each resident’s medication box. The review confirmed that all medications present were prescribed by a physician. However, upon review of facility records, it was observed that the facility was not consistently or accurately documenting medication administration on the residents’ Medication Administration Records (MARs), specifically by not initialing when medications were administered. In addition, the facility was not properly maintaining Centrally Stored Medication Destruction Records (CSMDR). For all five residents, the CSMDRs were missing the start dates for multiple medications, indicating that the dates the medications were first administered upon delivery to the facility were not documented.

During the visit, residents’ bedrooms were inspected. LPA Lee observed a video camera in Bedroom #3 for Resident 1 (R1) and in Bedroom #5 for Resident 2 (R2). Two small video monitoring screens were also observed in the entry/receiving area.