Facility Evaluation Report

Licensing Program Analyst (LPA) Debbie Correia conducted case management visit to obtain Licensee Baum's signature on an amended a report. LPA identified herself and stated the purpose of the visit.

LPA informed the Licensee Baum of the reason for the amended report and obtained signatures.

An exit interview was conducted with Licensee Baum. A copy of this report along with Licensee Rights (LIC9058 01/2016) will be provided to Licensee Baum. Signature below response confirms receipt of the documents.