Facility Evaluation Report

Licensing Program Analyst (LPA) Marcella Tarin arrived unannounced to conduct a Case Management-Deficiencies visit to follow up on deficiencies that were issued on 2/13/2025. LPA Tarin met with Staff S1 Rica Uy. LPA stated the purpose of the visit. S1 called Administrator (ADM) Olivia Velasquez via phone, ADM states she was out of the area. ADM authorized S1 to sign on her behalf. S1 states the facility has 18 residents and 5 staff.

On 2/13/2025 LPAs Manuel Monter and Kenneth Madrigal conducted the facility's annual inspection. Deficiencies were issued and a Plan of Correction (POC) was developed with the ADM. The ADM stated they would repair and correct the deficiencies cited, and submit a statement of understanding by the POC due dates of 2/14/2025 and 2/20/2025. The POCs were submitted to the Department.

LPA Tarin inspected the facility and it was observed to be clean, safe and in sanitary condition. LPA did not observe any leaks in the facility. LPA observed the following: dry wall in the facility bathroom has been repaired, the refrigerator is free of ice buildup, the back wall of the facility kitchen sink has also be repaired. LPA observed the backyard fence was repaired and not propped with a stick.

LPA reviewed Resident R1-R4's records and observed completed needs and services plans. LPA reviewed Staff S2-S4's records and observed signed physicians reports.

No deficiencies were cited during today's visit. An exit interview was conducted with S1 and a signed copy of this report was provided.