Facility Evaluation Report

Unannounced case management visit made out to this facility on 05/07/2026 by Licensing Program Analysts (LPA'S) Kesha Lewis and Melina Oropeza who was met by the facility designated Administrator, Janet Johns, at this time. A brief interview was conducted with the facility designated Administrator at this time.

The purpose of this case management visit was to conduct a quarterly visit as outlined from the Non Compliance Conference held on 03/04/2024 and the requirement to have increased monitoring at that time.

The focus of this quarterly visit was to review the following items that were initially brought forth on 03/04/2024:

Ensure all staff are compliant with all required training

Uphold all Personal Rights of the Residents

Maintain and conduct Personal Rights training and verification for new and existing employees

Facility designated Administrator must maintain oversight of facility staff for proper care and supervision

Make sure that this facility is following all Reporting Requirements

Updating policies and procedures for resident fall risks

Make sure that facility staff are always seeking timely medical attention

Update and maintain Needs/Appraisal Training for all staff

Maintain and train all care staff on proper documentation for the facility Communication Log

There were no deficiencies observed or cited during today's case management visit. Exit Interview