Facility Evaluation Report

On 11/7/24, Licensing Program Analyst (LPA) Arvin Villanueva conducted an unannounced Case Management - Annual Continuation visit at the facility to continue with the Annual Required Inspection visit initiated on 10/31/24. LPA initially met with a staff on duty (S1) and stated the purpose of the visit. The Administrator Debbie Loesch was notified of this visit and arrived shortly after with Assistant Administrator Ingrid Myers. Present during today's visit were 6 residents in care with 1 staff on duty (S1).

The LPA continued with facility visit to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. Facility is fire cleared for 6 non-ambulatory residents.

Review of 4 sample resident files (R1, R2, R3, R4) include review of Admission Agreement, Physician Reports, Needs and Services Plan, Centrally Stored Medication Record and Ambulatory Status. No issues were noted at this time.

Medication review of 2 sample residents (R3 and R5) include review of physician orders for over-the-counter medications. No issues were noted at this time.

Review of 3 sample staff files (S1, S2, and S3) include review of background clearance, First Aid/CPR certificate, Health Screen, Initial and Ongoing Training. Administrator will send updated First Aid/CPR for staff S2, Health Screen for S2 and S3, and associate S2 back to this facility.

Facility conducts monthly disaster drill and last drill was on 10/8/24. Facility has a dementia and infection control plan.

Administrator will also submit updated LIC500 and LIC308 to the Department.