Facility Evaluation Report

On 09/18/2023, Licensing Program Analysts (LPAs) Arielle Pascua and Christina Valerio arrived unannounced to this facility to conduct a case management visit. LPAs met with Facility Designated Administrator (FDA) Norma Borges and explained the purpose of the visit.

Current Census was 4. A brief interview was conducted with FDA Borges was conducted. There was one other staff member present at this facility at this time, Karen Marcos.

The purpose of this visit was to obtain documentation regarding S1.

It was learned during this visit that S1 was not associated at the time of the LPAs visit. LPAs asked for documentation to provide proof that S1 was associated. LPA Pascua was shown a letter to show S1's association but was not addressed to this facility. Upon review of Guardian it was observed that S1 was not associated until 12:44pm on 09/18/2023. It was stated that S1 started working as of today, however, based on review of the Medication Administration Record it was found that S1 has initialed for several medication administration records since 09/01/2023.

Deficiencies were observed during today’s visit. An immediate Civil Penalty has been issued for $500 for violation of 80019(e)(3). This civil penalty was due to S1 not being associated to the facility prior to working.

Citations can be found on the LIC 809–D. Failure to correct deficiencies may result in civil penalties. Appeal Rights were provided to facility staff Norma Borges.

An exit interview was conducted and copy of this report was provided to the facility at the end of this visit.