Facility Evaluation Report

Licensing Program Analyst (LPA) Simi Rai conducted an unannounced case management for annual continuation from 3/26/2026. LPA Rai met with Administrator, Carmen Buno and stated the purpose of today's visit.

LPA Rai reviewed at random 2 staff files and 2 resident files. 2 Out of 2 staff files were complete. 2 Out of 2 resident files were complete.

LPA Rai reviewed at random 2 medications and medication records. LPA Rai observed resident R1's 2 out of 8 medications did not have start date on the Centrally Stored Medication Log. LPA Rai observed R1's 1 out of 8 medications (MED1) which were centrally stored not recorded on the Centrally Stored Medication Log. LPA Rai and facility staff S1 counted the tablets remaining in MED1 were 39 tablets when the initial tablets in the medication when filled was 100 tablets. S1 stated the facility staff are administering MED1 to resident R1 1 tablet daily. LPA Rai observed 2 out of 8 medications (MED2 & MED3) did not have start dates written on the Centrally Stored Medication Log. LPA Rai and S1 counted tablets remaining in MED2 bottle which was 46 tablets, when originally it was filled with 100 tablets. LPA Rai and S2 counted tablets remaining in MED3 bottle which was 26 tablets, when originally it was filled with 90 tablets. S1 stated the facility staff are administering MED2 and MED3 to resident R2 1 tablet daily.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.