Facility Evaluation Report

Licensing Program Analyst (LPA) Arian Golbakhsh conducted an unannounced Case Management visit to follow up on an incident reported to Community Care Licensing (CCL). LPA was welcomed by, identified themselves to, and discussed the purpose of the visit to Executive Director Abraham Botello.

CCL received an incident report on November 24th, 2025 in which it was reported that on 11/14/25, a resident (identified as R1) was transported to the hospital during a visit from R1's Home Health provider. Per the report, the Home Health provider --who is a licensed medical professional, noted that an edema in R1's leg had worsened, in addition to a wound on their leg that produced a foul odor. The Home Health provider recommended R1 be taken to the hospital for evaluation and treatment. The report notes that R1 was treated at the hospital for an infection in their leg, and returned to the facility the following day. Per the report, R1's responsible party and primary care provider were notified, and wound care orders for Home Health updated.

On 11/24/25, CCL requested additional records for R1 for follow-up, but after no response, LPA conducted the Case Management visit. During today's visit, LPA conducted file review, interviews, and a health and safety visit with R1.

No Deficiencies were cited during today's visit. An exit interview was conducted with Executive Director Botello to whom a copy of this report was provided. Their signature below confirms receipt of this document.