Facility Evaluation Report

Licensing Program Analyst, Noel Wolf Petersen arrived unannounced to the facility to conduct a case management to finish some elements of the annual inspection. LPA met with the administrator Angelica Velasquez to explain the purpose of the visit. Current census is 4 residents over 60, 4 nonambulatory.

Status of the fire clearance updates, licensee called monday, not heard back yet. Licensee updated the LPA that the second home wanted to increase/bedridden hospice capacity as well. LPA gave guidance that a lic 200 making the requested changes and a facility sketch was needed to process the changes.

LPA had a conversation about the reporting requirements, Licensee provided the death reports physically. with the staff and the administrator. 4 residents were interviewed. 3 awake and responding positively to questions about thier care, 1 asleep.

LPA asked for death reporting documents by end of day 1/17/25 for the five resident's who have died from the last year: Hospice Admissions Agreement, Hospice Care Plan, Hospice Notes, Needs and Services Plans, MARs, Any incident reports, Any Service Notes, Any discharge summaries.

No citations issued at this time. A copy the report, was given to the administrator. exit interview conducted .