Facility Evaluation Report

Licensing Program Analyst (LPA) Magdaleno arrived unannounced to conduct a Case Management - Other visit and met with Administrator Lance Woodson.

This visit was to conduct to follow up and gather more information regarding an Incident Report (IR) submitted by the facility on 4/7/2026. The incident report detailed a resident (R1) who was observed with disorientation and heavy, labored breathing following a request for mouth wash. R1 was subsequently sent to the ER. Interview with staff and management indicated that mouth wash in the facility is non-toxic, and the reason for R1's ER visit was unrelated to the mouth wash. Facility will submit a follow up IR providing further information and diagnosis.

LPA also followed up on a change in facility management, Administrator Vincent Waller is no longer with the facility. Lance Woodson will be taking over as Administrator, facility will submit the following documents to Community Care Licensing in order to update Administrator:

Copy of active and current Administrator Certificate

Copy of Board of Directors Resolution Meeting Minutes Signed

LIC308 - Designation of Facility Responsibility

No deficiencies cited. Exit interview conducted with Administrator, whose signature on form confirms receipt.