Facility Evaluation Report

Licensing Program Analyst (LPA) Janira Arreola conducted an unannounced visit to the facility for case management. This report documents deficiencies found during the visit. LPA met with Administrator, Benito Encabo who was informed of the purpose of the visit. At the time of the visit there were (3) staff and (3) residents present. LPA conducted records review, walk through and interviews.

Records review for residents revealed (2) residents are on home health both resident did not have a care plan from their home health agencies present during the visit. Records review for (3) residents revealed that their LIC602 forms were not properly updated. Resident #1 (R1) had an LIC602 that had repeated and incomplete pages, with (2) pages indicating (2) different ambulatory statuses. Resident #2 (R2) has an LIC602 from 2023 which indicates a different cognitive diagnosis than R2's hospice care plan dated 08/14/2025. Resident #3 (R3) has a LIC602 form which has not been updated since 04/05/2024 and R3 has not been Therefore, LIC602 forms must be updated for the residents. LPA reviewed the care plans for the residents in care and found that all (4) residents had a care plan that was more than (1) year old.

Therefore the facility was cited for the records and plan of correction was created with the administrator. An exit interview was conducted and a copy was this report was reviewed and provided.