Facility Evaluation Report

LPA Johnson arrived unannounced to conduct a complaint investigation and case management visit. LPA met with Administrator Kelly Stern and explained the purpose of the visit.

LPA requested a tour of the facility, during the tour of the facility LPA and Administrator observed and photographed unlocked toxin/ cleaning supplies on the cleaning cart. The cart does lock and has a key; however, the locker area was being used to store paper supplies and not the cleaning product. (Citation given)

The facility's buildings and grounds needed attention in two areas: the first area included the vents in the hallways have no filters and are covered with build-up dust (photos taken). Also observed throughout the facility were broken or missing blinds in several rooms including the T.V. Room. (Advisories given)

The facility will not provide the department with copies of the resident face sheets. The facility stated that these are internal documents and only to be viewed and not copied for the department.(Citation given). LPA took photos of the face sheet to assist the investigation of the complaint. LPA was confronted about the photos and was told that the facility will not sign the reports. Because the LPA was observed taking photos of the face sheets. LPA asked Momo Duoa for copies of the facesheet again was told that a copy of the LIC 9020A was be provided. The form provided was not a LIC form but a facility form with similar information for all residents not the two residents that information was requested for R1 and R2.

The citations are included on the attached 809D Page.

An exit interview was conducted and a copy of this report and appeal rights were provided to the Administrator.