Facility Evaluation Report

Announced office meeting on 07/10/2026 by Licensing Program Manager (LPM) Lisa Rios and Licensing Program Analyst (LPA) Jason Lund who was met by Licensee Casey Blevins. LPM Licensing Program Manager Lisa Rios explained the reason for the meeting.

Licensee Casey Blevins agreed to the Department of Social Services Stipulation and Wavier; and Order on 5/29/2025. Licensee Casey Blevins will turn: A letter from the licensee and/or Board appointing the individual as the new Administrator, LIC308, Copy of current Administrator Certificate, all documentation that meets the education and/or experience requirements to be the Administrator, LIC 200 signed by the licensee or designee, LIC 500 to indicate the days/hours the Administrator is in the facility, and LIC 501 so that we can determine if the Administrator meets the education / experience requirements. Licensee Casey Blevins was offered TSP for the facility. LPA Lisa Rios made Licensee Casey Blevins aware of the two civil penalties that the facility has, 11/8/2021 for $500.00 and 3/25/2024 for $500.00. Licensee Casey Blevins will email LPA Lund the paperwork for the new administrator by 7/17/2026.

Exit Interview was held and a copy of this report was emailed to Licensee Casey Blevins.