Facility Evaluation Report

Licensing Program Analyst (LPA) Simi Rai conducted a 1-Year Required annual inspection visit. LPA Rai met with Staff (S3) Pamela Sinio. S3 stated 3 residents were at the facility and 1 resident was out of the facility. Administrator, Donna Lagman arrived to the facility during the visit.

During visit, LPA Rai reviewed 2 resident files and 2 staff files.

LPA Rai interviewed 2 staff (S1-S2) and ADM pertaining to the Case Management conducted on 12/28/2023. LPA Rai wanted to clarify information provided during the visit and obtain additional documents to include but not limited to R1's Appraisal/Needs and Services Plan.

LPA Rai obtained a copy of current LIC 500, which was updated 1/1/2024. ADM stated the facility night shift (10pm - 6am) is on-call shift and will not be reflected on the LIC 500. ADM stated their Program Plan for staff working night shift (10pm-6am) is on call and the facility does not have awake night staff.

LPA Rai will return another day to complete annual inspection. This report was reviewed with Administrator, Donna Lagman and a copy of the report was provided.