Facility Evaluation Report

Unannounced case management visit made out to this facility on 09/19/2025 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility designated representative, Kesha Jones, at this time. RM contacted the Administrator of record to explain the purpose of the visit and deliver the following. Administrator was unable to attend.

A brief interview was conducted with the facility designated Administrator over the phone who stated that permission was granted for the present facility staff person, Kesha Jones, to sign and accept all forms and documents with CCL at this time.

The purpose of this case management visit was to deliver the Exclusion Order to this facility at this time.

The Exclusion Order was explained to the facility staff person, Kesha Jones, and a copy of the forms and documents related to this action was conducted at this time.

Appeal Rights were explained and a copy was included in the forms and documents given to the facility staff person at this time.