Facility Evaluation Report

Licensing Program Analyst (LPA) Alviso conducted a Required - 1 Year visit, on 5/28/26 at approximately 2:00pm, and met with the newly hired Administrator Brooke Patterson.

Fire clearance is approved for 80 non-ambulatory residents, which includes 4 bedridden. Facility has a required infection control plan, and a required emergency disaster plan. Hospice care waiver approved for thirteen(13) residents. Facility has a dementia plan of operation.

LPA requested thirteen (13) resident files. LPA started file reviews.

LPA requested thirteen (13) staff files for review. LPA started reviewing staff training.

LPA discussed, with Brooke Patterson, the needed paperwork/documents and signatures of the CEO regarding the change the facility administrator. Brooke stated their understanding of the above, including the required board resolution regarding the hired/designated administrator, representing the managing Licensee/ GSL MGMT LIVING LLC.

LPA is requesting the following documents be updated and submitted by 6/28/26:

LIC500 - Personnel Report -ensure all staff are listed/titles/days & hours working

LIC610E (9-pages)-Emergency Disaster Plan (ensure to review and update as needed/required)

Infection Control Plan (ensure to review and update as needed/required)

Copy of LIC400 Handling of Client Cash Resources (include copy of surety bond if handling cash) Form must be completed by all facilities

Copy of current Administrator Certificate

The LPA will continue the annual at a later date.

No deficiencies cited during today's inspection.

Exit interview conducted with Administrator Brooke Patterson.