Facility Evaluation Report

Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced case management visit to conduct follow up regarding a self-reported incident report. LPA was greeted by, identified herself to, and explained the purpose of the visit with General Manager Karl Miller.

On 9/3/2024, the Department received an incident report and SOC341 Report of Suspected Dependent Adult/Elder Abuse from the facility that described an incident in which Resident 1 (R1) reported missing medication to facility staff. [General Manager was provided with LIC811 Confidential Names List to identify R1] Per incident report, facility management conducted a check of R1's room and interviewed R1 and relevant staff. Facility staff notified R1's responsible party. No injuries or adverse reactions were reported.

During today’s visit, LPA conducted a health and safety check, observed residents in care, reviewed facility records, interviewed Resident 1. Further follow-up is necessary.

No deficiencies were cited on today’s date. An exit interview was conducted with General Manager Karl Miller, whose signature below confirms receipt of a copy of this report, the LIC811, and the Licensee Appeal Rights (LIC9058 3/22).