Facility Evaluation Report

Licensing Program Analyst (LPA) Rebecca Borunda 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 Caregivers Carmelita Twite and Raymond Abedoza.

During today's visit, LPA observed residents in care, reviewed facility records, and briefly inspected the facility kitchen and medication cabinet. LPA was away from the facility for approximately one hour between 12:10pm and 1:10pm. Review of staff records and interviews revealed that Staff 1 (S1) had not completed a health screening prior to working in the facility. [Caregiver provided with an LIC811 Confidential Names List to identify S1] Additionally, LPA observed multiple medication bottles and boxes located in the unsecured kitchen refrigerator door. Caregiver Abedoza relocated the medication to the facility's locked medication refrigerator during LPA's visit. Therefore, the following deficiencies for unsecured medications and staff working without health screening were cited and noted on the attached LIC809-D pages. Review of past citations issued within a 12 month period revealed that the facility was cited for unsecured medications on 10/16/2024. Therefore, a civil penalty in the amount of $250 was issued for a repeat violation within a 12 month period and noted on the attached LIC421FC form.

Due to time constraints, the annual inspection could not be completed and a return visit on a subsequent day is needed.

An exit interview was conducted with Caregiver Raymond Abedoza, whose signature below confirms receipt of a copy of this report, the LIC811, the LIC421FC, and the Licensee Appeal Rights (LIC9058 3/22).