Facility Evaluation Report

Licensing Program Analyst (LPA) Albert Johnson conducted an unannounced case management visit to the facility on today's date for the purpose of speaking with the administrator regarding late annual fees.

LPA spoke with the administrator, and explained the purpose of the visit. Administrator stated that she did not pay the annual fees. She stated she needs to update her address in the system to receive her mail properly.

Deficiency cited on today's date. If proof is provided that all fees had been paid, this deficiency will be dismissed.

Exit interview conducted. Appeal rights given.

A copy of the appeal rights and a copy of this report was left.