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 Resident Care Director (RCD) Anthony Bawalan.

The facility is licensed for a maximum capacity of 136 non-ambulatory residents, 20 of which may be bedridden. The facility has a waiver for 20 hospice residents and has a fire clearance for delayed egress in the facility's memory care. During today’s visit, the facility had a census of 73 residents.

During today's visit, LPA toured the facility, reviewed facility records, and observed residents in care. During the facility tour, LPA observed four loose pills on the counter in Resident 1's (R1) private bathroom. [RCD was provided with LIC811 Confidential Names to identify R1] LPA checked R1's medicine cabinet and bathroom drawers and discovered multiple medication and supplement bottles. A interview with RCD Bawalan revealed that R1 was receiving medication management and the facility was centrally storing R1's medications. Additionally, review of R1's medical assessment dated 2/25/2025 revealed that R1 was unable to store their medications. RCD removed the medication and supplement bottles from R1's room and relocated them to the locked medication room during the visit. Therefore, a deficiency was cited for medication storage and noted on the attached LIC809-D page.

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 RCD Anthony Bawalan, whose signature below confirms receipt of a copy of this report, the LIC811 and the Licensee Appeal Rights (LIC9058 3/22).