Facility Evaluation Report

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced complaint visit and in conjunction conducted this case management for issues identified while conducting today’s visit. LPA Lopez identified herself and was granted entry by caregiver Pouya “Paul” Ghorbanpour and explained the purpose of the visit. LPA met with licensee Shawn Chapari and administrator Cindy Chapari who later arrived and joined the visit.

During LPA’s tour of the facility, LPA spoke with residents. Resident #1 (R1) had mentioned during their interview, that some outlets throughout the facility had shorts. During the interview, LPA was granted permission by R1 to plug in a charger. LPA observed that the outlet did have a short, as the outlet sparked when LPA plugged in the charger.

During further interviews it was discovered that resident #2 (R2) had medication in their drawer provided by their family. LPA observed that R2 did in fact have 2 medications in their drawer to assist with their bowel. Both medications were new and were unopened.

Deficiencies were observed and cited during today's visit and can be reviewed on the attached LIC809-D page of this report.

The report was discussed, plan of correction was jointly developed, and an exit interview was conducted with licensee Shawn Chapari and administrator Cindy Chapari. A copy of this report along with Licensee/Appeal Rights (LIC9058 3/22) were provided to licensee Chapari at the conclusion of the visit. The signature below confirms the receipt of these documents.