Facility Evaluation Report

At 9:00am on 06/09/2026, Licensing Program Analysts (LPAs) Arielle Pascua and Sulma Lopez arrived unannounced to this facility to conduct an annual visit. LPAs met with Staff Member (SM), Karen Langley and explained the purpose of the visit. LPAs asked SM Langley to conduct the Facility Designated Administrator (FDA), Kashminder Kaur to inform her that CCL was present at this time. At 10:15am, FDA Kaur arrived at the facility to meet LPA.

Current census was 31. A brief interview with FDA Kaur was conducted.

This facility is licensed to serve 32 residents 60 and older who may be non-ambulatory. This facility also holds a dementia plan on file and a hospice waiver for 32 residents.

LPAs Pascua and Lopez reviewed 6 resident files and 6 staff files. It was observed that 6 out 6 residents had an incomplete LIC625, Needs and Services Plan. 1 out 6 resident files revealed that a physician report was not signed by the physician. In addition, it was observed that 1 out of 6 staff files did not have a health screening conducted 6 months prior to their hire date. FDA Kaur has an active administrator certificate #7024979740 and expires on 08/29/2027. LPAs also followed up on an incident report received by the department on 1/07/2026. It was stated that on 01/06/2026, Resident 1 (R1), left the facility through the side gate and was found outside of the facility sitting in on the sidewalk in a nearby neighborhood. It was learned that staff was attending to another resident during this time and did not observed R1 leaving through the side gate. A review of the residents physician report conducted on 06/02/2025 reveals that the resident is unable to leave the facility unassisted.

The facility has conducted a fire drill log on 03/12/2026. Fire extinguishers observed were services by the local fire company on 04/10/2026.

A tour of the facility was conducted. A tour of the residents rooms were conducted. Furniture and furnishings were sufficient to meet resident needs.