Facility Evaluation Report

Licensing Program Analyst (LPA) Lizzette Tellez conducted an unannounced case-management visit. LPA met with Assistant Administrator, Myra Palmer, and discussed the purpose of the visit.

This visit was initiated due to the death of Client #1 (C1). Ms. Palmer was provided with Confidential Names Form, in order to identify C1. It was reported to Community Care Licensing (CCL), that C1 passed away on 12/10/21.

During today's visit, LPA toured the facility, interviewed Ms. Palmer, and obtained copies of C1's records. A copy of C1's death certificate was requested to be provided by Administrator, Cyralynn Mabalot, once received. No immediate health and/or safety concerns were observed during the visit.

No deficiencies were cited during today's visit. An exit interview was conducted with Ms. Palmer, and a copy of this report along with Licensee/Appeal Rights (LIC9058 01/16) were provided to the Administrator via email. An electronic receipt of confirmation was requested to be sent by the Administrator upon receipt of the documents.