Facility Evaluation Report

Licensing Program Analyst (LPA) Steve Chang conducted an unannounced Case Management - Legal/Non-compliance inspection and met with Administrator (ADM) Annie Inciso.

The purpose of the visit is to ensure the facility is adhering to the Compliance Plan submitted to Community Care Licensing (CCL) office after a Non-Compliance Conference held on 12/03/2024. The case management of inspections will be conducted every 3 months for 2 years.

2 residents went to day program. LPA observed 4 residents and 4 staff in the facility.

LPA reviewed and discussed the plan of correction for the deficiencies and the plan of operation the facility submitted for the NCC meeting with the ADM.

LPA reviewed the appraisal needs and service plan of 6 residents.

LPA toured the facility with ADM. LPA checked the 3 door alarms of the facility and 2 moving detectors alarms outside the building. All were observed working.

LPA reviewed the facility staff training log. LPA reviewed the 15 minutes resident checking log.

Exit interview was conducted with ADM. The report was provided to ADM for signature. A copy of the report was provided to ADM.