Facility Evaluation Report

On 10/11/2024, Licensing Program Analyst (LPA) Kimberly Viarella made an unannounced visit to this facility to open a case management visit regarding the recent death of a resident, R1. LPA identified herself upon arrival, stated the purpose of the visit and asked to speak with the Designated Facility Administrator, Raehan Astronomo. The Administrator was not at the facility but staff contacted him by phone and Mr. Astronono stated he would arrive in15 minutes.

This LPA conducted a walkthrough of the facility. Currently all residents were attending day program activities. There were 2 staff present at the time of this inspection. All the living areas and the 4 resident bedrooms contained all of the required furniture, furnishings, and lighting to be in compliance at this time.

R1's client file with R1's Admission Agreement, Emergency ID/ Contact sheet, Appraisal / Care Plan, medical information including LIC 602, medication logs for approximately August - October 2024, Any incident reports for the past year,

LPA also requested an LIC 500, a resident roster, and facility sketch.

LPA met with Raehan Astronomo briefly but due to time constraints, this LPA will return at a later date to continue this case management.

No deficiencies were observed or cited during today's visit. A copy of this report was provided and an exit interview was conducted.