Facility Evaluation Report

Licensing Program Analyst (LPA) conducted an unannounced case management - incident investigation visit today, and met with Administrator (ADM) Bani Kaur. Two staff (S1, S2), 4 residents (R1 - R4), and ADM were interviewed.

The following document were obtained including staff schedule, resident admission agreement, resident physician report, Appraisal Needs and Service Plan, medication list record, Rosters of staff and residents, and the contact information of conservator and case manager.

The Department needs more investigation for this incident.

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