Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted a case management with incident visit today, and met with Administrator (ADM) Kareeb Harbin, Clinic Manger Bory Kham (BK) and Program manager Rachael Barreto (RB). The purpose of this visit was for the incident report dated on 12/16/2022.

LPA interviewed ADM, BK, RB, a staff (S1), and a resident (R1).

R1's Appraisal and Needs and Service plan, R2's Appraisal and Needs and Service plan, R1's physician report, R2's physician report, and the first two weeks of staff schedule were obtained.

The Department needs further investigation.

Exit interview was conducted with ADM. This report was provided to ADM for signature. A copy of this report was provided to ADM.