Facility Evaluation Report

Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced Required 1-Year visit. The facility file was reviewed prior to the visit. LPA was greeted by, identified herself to, and explained the purpose of the visit with Administrator Natalia Ozorio-Verdugo.

During today's visit, LPA toured the facility, reviewed facility records, and observed residents in care. Review of resident records revealed that the LIC602 physician's report for Resident 1 (R1) noted that R1 had a diagnosis of dementia and was dated 2/15/2023 and the LIC602 physician's report for Resident 2 (R2) noted that R2 had a diagnosis of dementia and was dated 6/6/2023. [Administrator was provided with an LIC811 Confidential Names List to identify R1 and R2]. LPA was away from the facility for approximately one hour between 1:15pm and 2:15pm. Due to time constraints, the annual inspection could not be completed and a return visit on a subsequent day is needed.

The following deficiency was cited for annual medical assessments and noted on the attached LIC809-D page.

An exit interview was conducted with Administrator Natalia Ozorio-Verdugo, whose signature below confirms receipt of a copy of this report, the LIC811, and the Licensee Appeal Rights (LIC9058 3/22).