Facility Evaluation Report

Licensing Program Analyst (LPA) Angelica Boyles conducted an unannounced Case Management visit to cite deficiencies identified during a separate complaint investigation. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Caregiver Nita Pabustan . LPA also spoke with Administrators Alex Boskoski and Dragana Lekovic over the phone.

During a facility tour, LPA observed resident records containing medication information stored underneath a table, easily accessible. Th ese records were not secured or safeguarded to protect the confidentiality of their contents.

During a record review of Resident #1 files (R1) [See LIC811 Confidential Name List for a description of select person identifiers used in this report.] it was revealed that there were no previous records for R1's centrally stored medication prior to 10/20/25. Per Admission's Agreement, R1 was admitted to the facility 4/26/25.

During interviews with staff, it was revealed that R1 is currently at the hospital. LPA also reviewed R1's records that indicated at least two other prior hospital visits. LPA reviewed the Department's internal database of reports received from facilities which revealed that the Licensee did not submit any Unusual Incident/Injury Reports (LIC 624) to the Department of these incidences per reporting requirements.

Three deficiencies were cited per California Code of Regulations, Title 22 (refer to the attached LIC 809-D page). A Plan of Correction was jointly developed with Administrators. An exit interview was conducted with Caregiver Nita Pabustan, to whom a copy of this report, the LIC 809-D, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.