Facility Evaluation Report

Licensing Program Analyst (LPA) Rebecca Borunda conducted an unannounced case management visit to continue the Required 1-Year visit from 9/22/2025. LPA was greeted by, identified herself to, and explained the purpose of the visit with Caregiver Raymond Abedoza.

During today's visit, LPA toured the facility, observed residents in care, reviewed facility records, and interviewed residents and facility staff. During the tour of the facility, LPA observed unlocked cleaning chemicals stored under the sink in a common bathroom for resident use. Caregiver Abedoza relocated the cleaning chemicals to locked storage during LPA's visit. Additionally, LPA observed unlocked cleaning chemicals in a bathroom that Caregiver Abedoza stated was for staff use only and residents did not use, however, the bathroom was unlocked. Caregiver Abedoza locked the bathroom during LPA's visit. Therefore, the following deficiency for unsecured cleaning chemicals was cited and noted on the attached LIC809-D page. Review of past citations issued within a 12 month period revealed that the facility was cited for unsecured cleaning chemicals 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 LIC421FC, and the Licensee Appeal Rights (LIC9058 3/22).