Facility Evaluation Report

On August 18, 2025, LPA Manuel Monter conducted a POC visit. LPA met with Administrator /Licensee(ADM) Evelyn Canonizado . LPA explained the purpose of the visit.

On August 8, 2025, the facility was issued the following Type A Deficiencies with a POC date August, 9 2025. As of today’s visit, the licensee has not submitted or corrected citations resulting in civil penalties.

The following deficiencies during a case management/ conclusion of a complaint investigation on August 8, 2025 are as follows:

• 80078(a), Responsibility for Providing Care and Supervision (Type A), Issued initial Civil Penalty (CP) of $800.00 beginning 8/10 and will continue to accrue until corrected.

• 80065(a), Personnel Requirements (Type A) , Issued initial CP of $800.00 beginning 8/10 and will continue to accrue until corrected.

On August 8, 2025, the facility was issued the following Type B Deficiencies with a POC date August 9, 2025. As of today’s visit, the licensee has not submitted or corrected citations resulting in civil penalties.

The following deficiencies during a case management/ conclusion of a complaint investigation on August 8, 2025 are as follows:

• 80022(k), Plan of Operation (Type B), Issued initial Civil Penalty (CP) of $200.00 beginning 8/16 and will continue to accrue until corrected.

• 85079(a),Activities (Type B) , Issued initial CP of $200.00 beginning 8/16 and will continue to accrue until corrected. Page 1 Out of 2.