Facility Evaluation Report

Licensing Program Analyst (LPA) Alyssa Ramirez conducted an unannounced Case Management visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Administrator Rayne Fernandez.

Today’s visit was in response to an incident which licensee self reported via an LIC624 Incident Report. On 11/4/24 the facility reported an AWOL of Client#1 (C1 – See LIC811 Confidential Names List for identification of C1). C1 was located within 3-4 minutes of leaving facility and returned to facility with staff. The staff followed the facility elopement/AWOL protocol.

LPA briefly toured the facility, performed a welfare check on residents in care, 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 Administrator, whose signature on this form confirms receipt of these documents.