Facility Evaluation Report

On 06/02/2026, Licensing Program Analyst (LPA) Shakaricka Hughes conducted an unannounced visit to the facility. The purpose of this visit was to conduct a case management visit regarding residents mobility status and ongoing care requirements. The licensee/administrator is currently requesting an increase for the facility's Hospice waiver. LPA met with Kirendeep. The current census is 5, with 1 facility staff present.

During today's visit LPA reviewed the facility sketch and fire clearance documentation maintained by the Dept to verify the facility's approved capacity, designated resident rooms, and authorized ambulatory status. Additionally, LPA reviewed the LIC 602 Physician's Reports for all residents in care.

LPA advised the administrator that an increase Hospice waiver is currently under review by the Dept, and Exception waiver has been granted to the facility in order to retain resident (R1), who resides in the facility but is currently hospitalized due to changes in their health status and care needs requiring the resident to need Hospice care.

An exit interview was conducted, and a copy of the LIC 809 report, and Exception Waiver was provided to the facility.