Facility Evaluation Report

Unannounced case management visit made out to this facility on 12/11/2023 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility caregiver, Judith Levita, who was briefly interviewed at this time. It was learned that this caregiver was the sole staff person present at this time while the other staff person was out of the care facility in order to pick up a resident from their day program. There were (4) residents present at this time.

This LPA requested that Mrs. Levita go ahead and contact the facility designated Administrator, Jessica Dizon, to inform her that CCL was present at this time.

The purpose of this visit was to follow up on the items that were requested on an earlier visit dated on 11/15/2023 which have not been received by this LPA. Several attempts were made by this LPA to obtain these forms and documents so now a follow up visit had to be made.

These were the following forms and documents that were originally requested on 11/15/2023:

Any, and all, LIC 624s related to R1 since admission