Facility Evaluation Report

Licensing Program Analysts (LPAs) Janira Arreola, Imaculada Vasquez, and Toni Nwala, conducted an unannounced visit to the facility in order to conduct a case management. LPA met with Administrator, Samuel De Guzman, who was informed of the purpose of the visit. During the visit, LPA conducted interviews, documented observations, conducted a walk through, and conducted records review.

A health and safety check was conducted on the facility and residents, no immediate health or safety issues were observed. During the time of the visit there was a deficiency identified. (1) Resident, Resident #1 (R1) did not have an incident report done for the resident's death within the required time frame. Therefore a deficiency was cited and a plan of correction was documented.

An exit interview was conducted where this report, appeal rights, and deficiency page was reviewed and provided.