Facility Evaluation Report

Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced Case Management visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Executive Director

Today’s visit was in response to an incident which licensee self-reported via an SOC341. On 09/17/2024 The report described Resident #1 (R1 – See LIC811 Confidential Names List for identification of R1. R1's Personal belongings were missing from R1's apartment. R1's apartment was thoroughly searched and Local Law enforcement, and the Ombudsman was notified.

LPA briefly interviewed staff, and obtained copies of pertinent facility records. No deficiencies were observed or cited on this date.

An exit interview was conducted, and a copy of this report and Licensee Rights LIC 9058 (03/22) were left with the Director, whose signature on this form confirms receipt of these documents.