Facility Evaluation Report

Unannounced case management visit made out to this facility on 11/15/2023 by this Licensing Program Analyst (LPA) Charlie Yang who was met by the facility caregiver, Judith Levita, and requested to go ahead and contact the facility designated Administrator to inform him/her that CCL was present at this time.

The facility designated Administrator, Jessica Dizon, arrived later on to this facility.

A brief interview was conducted with the facility designated Administrator Jessica Dizon.

Current census was 5 residents, of which one, was a new move-in while this LPA was present.

The purpose of this case management visit was to follow up on an incident that was reported into CCL in regards to a resident R1.

The following forms and documents were requested solely for resident R1 to be copied and submitted into CCL for review by this LPA:

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

Further review of the forms and documents will be conducted upon receipt by this LPA. Exit Interview