Facility Evaluation Report

Unannounced post licensing visit made out to this facility on 03/02/2022 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility caregiver Harveen Sidhu. This LPA requested that she go ahead and contact the facility designated Administrator to inform him that CCL was present at this time. The facility designated Administrator, Ricky Nolasco, was present and was briefly interviewed by this LPA at this time. Administrator certificate was reviewed for Ricky Nolasco and observed to have expired on 09/28/2022.

The facility designated Administrator stated that he was currently showing to be "Pending" and all documents and forms, including paid fee, have been submitted at this time.

Current census was 5 residents of which there weren't any residents under the care of hospice and no residents were under the care of home health. This facility does have an approved hospice waiver to accept and retain up to (3) hospice residents.

Visit was conducted in collaboration with the annual visit as well.