Facility Evaluation Report

Licensing Program Analyst (LPA), Kristina Ryan conducted an unannounced case management visit. LPA was granted entrance by House Manager, Rosaura Estrada and met with Direct Service Provider, Jayme Ponce De Leon and Rosaura Estrada. LPA was granted entrance after disclosing the purpose of the visit.

This visit was initiated due to a death report received on October 17, 2021. The administrator was provided with LIC 811 - Confidential Names Form, in order to identify C1. During today's visit, LPA toured the facility, requested resident records, conducted interviews, and observed clients in care. No immediate health and/or safety concerns were observed during the visit.

No deficiencies were issued during today's visit. An exit interview was conducted with Jayme Ponce De Leon and a copy of this report, along with Licensee Rights (LIC 9058 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.