Casa Del Sol

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Caregiver Priscilla “Lily” Dacanay. LPA then met with the administrator's assistant, Edgar Dacanay, who arrived later during the visit. Today's visit was in response to an LIC624 Incident Report, which licensee self-submitted to the CCLD San Diego Regional Office (received on 04/10/2023). According to the LIC624: on 04/08/2023, Resident #1 (R1) eloped from the facility (left without staff supervision). [See LIC 811 Confidential Names List for a description of person identifiers used in this report.] Staff immediately notified law enforcement, who located and returned R1 to the facility unharmed/uninjured. As of CCLD’s 07/03/2023 site visit, R1 had since moved out of the facility and was not present. During today’s visit, LPA performed a facility tour and welfare check on the remaining residents, finding no immediate safety concerns. LPA also reviewed resident care records and interviewed relevant facility staff. According to their latest LIC602 Physician’s Report (dated 03/10/2023): R1 was diagnosed with Schizophrenia and Dementia, and their doctor determined that they were not able to safely leave the facility unassisted. Multiple staff interviews corroborated: On the date of the incident, R1 was initially exercising/walking around the facility’s front and back yards, but still remained on the facility premises. Staff visually checked on R1 regularly. Upon first observing that R1 had walked off-property, staff timely phoned law enforcement, R1’s “emergency contact” person, R1’s case worker, and CCLD. While law enforcement searched for R1, facility staff also drove around the adjacent neighborhoods to search for them. Law enforcement located R1 around 1.5 hours later at a nearby park and returned them to the facility unharmed/uninjured. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] R1 had exercised on prior occasions in the facility’s yards, without safety problems. A preponderance of evidence does not exist to show that licensee did not provide needed observation to R1, or that licensee did not meet reporting requirements. No deficiencies were cited for the incident itself. However, during today’s record review (and corroborated by staff, LPA observed that: a) Licensee did not possess an Absentee Notification Plan for R1, Resident #2 (R2), Resident #3 (R3), Resident #4 (R4), Resident #5 (R5), or Resident #6 (R6), as was required; b) Licensee did not possess evidence of receipt of resident’s Personal Rights by R1, R2, R3, R4, R5, or R6, as was required; and, c) Licensee did not possess an initial personal property inventory for R1, R2, R3, R4, R5, or R6, as was required. Additionally, d) Licensee did not possess a completed LIC602 Physician’s Report (or equivalent medical assessment) for R3, R4, and R5; and e) R6, who was diagnosed with Dementia per medical records, did not have an LIC602 Physician’s Report (or equivalent medical assessment) completed/updated within the last year, as was required. Deficiencies were cited per California Code of Regulations, Title 22, and California Health and Safety Code (refer to the attached LIC 809-D). Plans of Correction were jointly developed with the licensee. LPA also provided Technical Assistance to Licensee regarding staff auditory and/or alert devices on exit doors. An exit interview was conducted with Edgar Dacanay, to whom a copy of this report, the LIC809-D pages, the LIC9012-TA page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.the state’s words, verbatim · CDSS document, Jul 3, 2023

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.317 · Plan of correction due date: Aug 2, 2023

1569.317 Absentee Notification Plan for Missing Residents: “Every residential care facility for the elderly…shall, for the purpose of addressing issues that arise when a resident is missing from the facility, develop and comply with an absentee notification plan…” This requirement was not met, as evidenced by: Based on records and interviews, licensee did not develop an absentee notification plan for 6 of 6 residents (R1, R2, R3, R4, R5, and R6), which posed a potential safety risk to persons in care.the state’s words, verbatim · CDSS document, Jul 3, 2023

Plan of correction: Licensee agreed to write an Absentee Notification Plan (meeting the requirements of Heath and Safety Code Section 1569.317), and to place a copy of it in the resident files of R2, R3, R4, R5, and R6, respectively. Licensee agreed to train its current direct care staff on this Absentee Notification Plan. Licensee agreed to E-mail LPA a copy of the Absentee Notification Plan, and the training sign-in sheet, by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87458(a) · Plan of correction due date: Aug 2, 2023

87458 Medical Assessment: “(a) Prior to a person's acceptance as a resident, the licensee shall obtain and keep on file, documentation of a medical assessment, signed by a physician, made within the last year. The licensee shall be permitted to use the form LIC 602 (Rev. 9/89), Physician's Report, to obtain the medical assessment.” This requirement was not met, as evidenced by: Based on records and interviews, for 4 of 6 residents (R1, R3, R4, and R5), prior to their acceptance as a resident, licensee did not obtain and keep on file, documentation of a medical assessment, signed by a physician, which posed a potential health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 3, 2023

Plan of correction: Licensee agreed to coordinate with physicians, responsible parties, and/or case managers, as needed, to obtain a completed and signed LIC602 Physician’s Reports for R3, R4, and R5, and to place them in their respective resident files. Licensee agreed to update its internal admission policies/procedures to make this document a pre-requisite for move in. Licensee agreed to E-mail LPA a copy of the LIC602’s for R3, R4, and R5, by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(c)(5) · Plan of correction due date: Aug 2, 2023

87705 Care of Persons with Dementia: “(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs.” This requirement was not met, as evidenced by: Based on records and interviews, licensee did not ensure that 1 of 6 residents (R6), who was diagnosed with dementia, had a medical assessment performed within the last year, which posed a potential health, safety, and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 3, 2023

Plan of correction: Licensee agreed to coordinate with R6’s physician, responsible party, and/or case manager, as needed, to obtain a new/updated LIC602 Physician’s Report for R6, and to place in R6’s resident file. Licensee agreed to mark their internal calendar to remind them that for every resident diagnosed with dementia, Licensee will need to facilitate a new LIC602 within the next 12 months. Licensee agreed to E-mail LPA a copy of R6’s new/updated LIC602, by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87468(b)(1)(A) · Plan of correction due date: Aug 2, 2023

87468 Personal Rights: “(b) At the time the admission agreement is signed, a resident and the resident's representative shall be personally advised of and given a copy of: (1) The personal rights of residents specified in Sections 87468.1…and 87468.2…(A) The licensee shall have each resident and the resident's representative sign a copy of these rights, and the signed copy shall be included in the resident's record.” This requirement was not met, as evidenced by: Based on records and interviews, for 6 of 6 residents (R1, R2, R3, R4, R5, and R6), Licensee did not ensure that a signed copy of the resident rights was included in the residents’ records, which posed a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 3, 2023

Plan of correction: Licensee agreed to coordinate with residents and/or responsible parties (where applicable), to complete signed LIC613C forms (“Personal Rights of Residents in Privately Operated Residential Care Facilities for the Elderly”) for R2, R3, R4, R5, and R6, and to place them in their respective resident files. Licensee agreed to update its internal admission policies/procedures to ensure the LIC613C is completed at or before time of move-in. Licensee agreed to E-mail LPA a copy of the LIC613C signature pages for R2, R3, R4, R5, and R6, by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87218(a)(1) · Plan of correction due date: Aug 2, 2023

87218 Theft and Loss: “(a) The licensee shall ensure an adequate theft and loss program as specified in Health and Safety Code Section 1569.153. (1) The initial personal property inventory shall be completed by the licensee, and the resident, or the resident’s representative.” This requirement was not met, as evidenced by: Based on records and interviews, for 6 of 6 residents (R1, R2, R3, R4, R5, and R6), Licensee did not maintain a personal property inventory, completed by the licensee and the resident and/or their representative, which posed a potential personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 3, 2023

Plan of correction: Licensee agreed to coordinate with residents and/or responsible parties (where applicable), to complete LIC621 forms (“Client/Resident Personal Property and Valuables”) for R2, R3, R4, R5, and R6, and to place them in their respective resident files. Licensee agreed to update its internal admission policies/procedures to ensure the LIC621 is completed at or before time of move-in. Licensee agreed to E-mail LPA a copy of the signed LIC621s for R2, R3, R4, R5, and R6, by the POC due date.

Allegation investigated: Staff did not obtain medical care for resident Staff did not follow resident’s care plan Staff did not administer medication as prescribed Staff did not notify resident's authorized representative of a change in condition

Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced complaint visit to deliver findings on the above-mentioned allegations. LPA gained access to the facility, identified herself, and met with Administrator, Vida Dacanay to discuss the purpose of the visit. On March 13, 2023, Community Care Licensing (CCL) received a complaint alleging that staff did not obtain medical care for resident (R1) [an LIC 811 Confidential Names List was provided to staff to identify the resident]. It was specifically alleged that R1 did not receive medical care for a pressure injury on their ankle until it was discovered by an outside source on March 6, 2023. On March 7, 2023, R1 was taken to the Emergency Room for evaluation. Based on physician's report, R1 had a full thickness ulceration stage 4 with infection. The report indicated the pressure injury was in existence for about 1 - 2 weeks, due to the drainage found on bed sheets. Immediate wound care was provided by the medical provider at the hospital and a referral was placed for general surgery. (Continue on LIC9099C) Substantiated (Continue from LIC9099) The physician prescribed a full course of antibiotic treatment and R1 returned to the facility. An ankle x-ray was also ordered to evaluate for possible osteomyelitis, (infection in the bone). During a visit conducted on March 20, 2023, it was observed that R1 received wound care by a licensed vocational nurse (LVN). According the LVN, the pressure injury was healing and R1 would continue to receive wound care by the LVN three (3) times per week. On April 17, 2023, during another visit at the facility, it was observed that R1 received wound care by the LVN. According to the LVN, the pressure injury had already improved to a level 2. During staff interviews, it was indicated that on or about Tuesday February 28th and on Thursday, March 2, 2023, staff informed facility management that R1’s right ankle appeared with red discoloration and had a small size “pimple”. Staff also indicated they had noticed stains on the bed sheets and informed facility management. Staff maintained during interviews they did not know the source of the stains because the ankle condition did not appear to be draining and assumed the stains on the sheets were due to other liquid spills. Staff were instructed by management to clean ankle with saline solution, change socks daily and reposition ankle periodically. During an interview, facility management indicated they did not seek additional medical attention because R1 was already receiving medical care by a third-party medical provider at the facility. Based on the evidence obtained during the investigation, licensee did not arrange for medical care as appropriate to treat R1’s observed medical condition as required by Title 22 regulations. It was also alleged that staff did not follow resident’s care plan. Detailed review of R1’s service plan indicated that R1 had a high risk of skin impairments related to bed bound status. The service plan indicated that staff were required to check R1 for comfort and reposition every two (2) hours. In addition, staff were required to check R1’s bodily pressure points and to assess skin integrity daily as needed. The coordination of care agreement between the facility and the medical provider indicated that facility staff were responsible for contacting R1’s medical provider with any needs, concerns, or changes in condition. R1’s care plan also required facility staff to review resident’s status on an ongoing basis with the medical care team and to notify the care team of changes in R1’s status. During interviews, staff indicated they informed facility management when they became aware R1’s ankle was red and had a “pimple”. Staff also informed facility management when R1’s bed sheets were observed to have stains of what appeared to be bodily fluids. During interviews, licensee did not provide additional details and testimony was inconclusive. (Continue on LIC9099C) (Continue from LIC9099C) Based on the information obtained during interviews with staff and outside sources it was determined that licensee did not coordinate medical care as the care plan required when R1 experienced a change in condition. It was also alleged that staff did not administer medication as prescribed. On March 20, 2023, during a visit at the facility a detailed review of R1’s medication administration records disclosed that several medications were not administered per doctor's orders. Acetaminophen was ordered as needed for pain, Lorazepam was ordered as needed for anxiety, and Risperidone was ordered as needed for agitation. All three medications were not administered to R1 from February 1, 2023, to March 20, 2023. Observations determined the medicine bubble packs contained all the medication. During staff interviews, it was indicated that medications were not administered as prescribed because an outside source did not allow staff to give the medications. As a result, according to staff, R1 did not sleep through the night and was restless during the day. In addition, staff indicated R1 often showed symptoms of anxiety and agitation which made it difficult to provide care. Based on observations, staff interviews and records review there was sufficient evidence to support the allegation that staff did not administer medications in accordance with doctor's orders. Lastly, it was alleged that staff did not notify resident's authorized representative of a change in condition. It was specifically alleged that staff did not notify responsible party when R1 had a pressure injury on ankle. During interviews, staff consistently stated they informed facility management of R1’s change in condition when they observed the ankle with red skin discoloration. Facility management indicated they did not notify R1’s responsible party. According to facility management, the responsible party used to visit on a daily basis and provided care to R1, so they assumed R1’s responsible party was aware of the ankle pressure injury. Based on the evidence obtained during the investigation, licensee did not notify responsible party of change in condition as required by Title 22 regulations. (Continue on LIC9099C) (Continue from LIC9099C) The Department has investigated the above-mentioned allegations and has found that there was sufficient evidence to corroborate the above allegations. Therefore, these allegations are deemed to be substantiated. A substantiated finding means the allegation is valid because the preponderance of the evidence standard has been met. Deficiencies were cited per Title 22, Division 6, Chapter 8 of the California Code of Regulations and are listed on LIC 9099-D. A plan of corrections was developed with Administrator, Dacanay. An exit interview was conducted with Administrator, Dacanay and a copy of this report, Confidential Name List (LIC 811), along with Licensee/Appeal Rights (LIC 9058 03/22) were provided at the conclusion of the visit. (Continue from LIC9099A) R1 was bedbound and diagnosed with spasticity which caused R1 to have exaggerated deep reflexes and repetitive jerky motions especially when touched or moved. During interviews, staff stated that they did not know the source of the injury and denied any abuse. However, staff explained that due to R1’s medical condition, R1 would often become agitated and combative towards staff during incontinence care or repositioning. According to the care service plan, R1 required two-person assist and would often resist care by aggressively moving their arms and accidentally hitting staff or themselves during the process. Staff also indicated that the padding on R1’s bedrail had been removed by an outside source, which could have resulted in R1 accidentally hitting their face on the corner of the bedrail when switching sides. During a visit conducted on March 22, 2023, R1 was observed using the bed rail to pull themselves up to switch sides and the position of their face was in close proximity (approximately 2-inches) from the edge of the bed rail. During interviews, staff, residents, and outside sources indicated they had never witnessed any staff member mistreating or physically abusing R1 or any of residents. Based on the observations, review of records and interviews conducted with relevant witnesses, it appeared R1’s bruised eyelid may have resulted from R1 accidently hurting themselves with the bedrail. There was no evidence found of physical abuse by facility staff. CCL was not able to gather any corroborating evidence that supports this allegation. Therefore, this allegation is deemed to be unsubstantiated, as there is not a preponderance of evidence to prove the alleged violation occurred. An exit interview was conducted with Administrator, Dacanay and a copy of this report, Confidential Name List (LIC 811), along with Licensee/Appeal Rights (LIC 9058 03/22) were provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Apr 21, 2023 · control 08-AS-20230313152727

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(1) · Plan of correction due date: May 22, 2023

87465(a)(1) Incidental Medical and Dental Care. The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidence by: Based on observations, interviews and records review, the licensee did not arrange for medical care as appropriate to treat R1’s observed medical condition, which posed a potential health risk to 1 of 5 persons in care.the state’s words, verbatim · CDSS document, Apr 21, 2023

Plan of correction: Licensee agreed to conduct in service training to ensure medical care is arranged as appropriate to all residents in care. The training will be delivered by an independent contractor for all staff including licensee. Documentation of completion of training should be submitted to CCL by POC date of 5/22/2023.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(C)(2) · Plan of correction due date: May 22, 2023

87633(d) Hospice Care of Terminally Ill Residents. The licensee shall ensure that the hospice care plan is current, accurately matches the services actually being provided, and that the client’s care needs are being met at all times. This requirement was not met as evidence by: Based on observations, interviews and records review, the licensee did not coordinate medical care as the care plan required for R1, which posed a potential health risk to 1 of 5 persons in care.the state’s words, verbatim · CDSS document, Apr 21, 2023

Plan of correction: Licensee agreed to conduct in service training to ensure the needs of all residents are being followed as specified in the care plan. The training will be delivered by an independent contractor for all staff including licensee. Documentation of completion of training should be submitted to CCL by POC date of 5/22/2023.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(C)(2) · Plan of correction due date: May 22, 2023

87465(C)(2) Incidental Medical and Dental Care. Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidence by: Based on observations, interviews and records review, facility staff did not administer medications in accordance with physician’s orders for R1, which posed a potential health risk to 1 of 5 persons in care.the state’s words, verbatim · CDSS document, Apr 21, 2023

Plan of correction: Licensee agreed to conduct in service training on medication administration, storage and record keeping. The training will be delivered by an independent contractor for all staff including licensee. Documentation of completion of training should be submitted to CCL by POC date of 5/22/2023.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87466 · Plan of correction due date: May 22, 2023

87466 Observation of the Resident. The licensee shall ensure that residents are regularly observed for changes in physical,... the licensee shall ensure that such changes are documented and brought to the attention of the resident's physician and the resident's responsible person. This requirement was not met as evidence by: Based on observations, interviews and records review, licensee did not notify R1’s responsible party of change in condition, which posed a potential health risk to 1 of 5 persons in care.the state’s words, verbatim · CDSS document, Apr 21, 2023

Plan of correction: Licensee agreed to conduct in service training on reporting requirements. The training will be delivered by an independent contractor for all staff including licensee. Documentation of completion of training should be submitted to CCL by POC date of 5/22/2023.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an announced visit to pick up records related to an ongoing investigation. LPA was greeted by Caregiver, Alma Jaramillo, to whom LPA identified herself to, and discussed the purpose of the visit. During the visit, LPA toured the facility with Caregiver, Jaramillo. In addition, LPA interacted briefly with residents in care, and reviewed and obtained copies of facility records. An exit interview was conducted with Jaramillo, to whom a copy of this report and the Licensee's Rights (LIC9058 01/16) was provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Apr 17, 2023

Allegation investigated: Staff hit resident Staff physically abused resident(s) Staff did not provide the dietary meal quantity to meet residents' needs

Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced complaint visit to deliver investigative findings. LPA was greeted by, identified herself to, and discussed the purpose of the visit with Caregiver, Alma Jaramillo. Administrator, Vida Dacanay joined the meeting a bit later. The Department investigated the above listed complaint allegations. The investigation consisted of a tour of the facility, multiple interviews with residents, staff and outside sources, and facility records review. On September 9. 2022, Community Care Licensing (CCL) received a complaint alleging that a facility staff (S1) member hit a resident (R1). [an LIC 811 Confidential Names List was provided to staff to identify the Resident (R1) and Staff (S1)]. It was specifically alleged that S1 hit R1 on the buttocks during incontinence care because R1 was resisting care. (Continue at LIC9099C) Unsubstantiated (Continue from LIC9099) It was also alleged that S1 put a pillow over R1’s face because they were making noises. The dates and times of when these alleged incidents occurred were not identified and there were no reported injuries. Staff S1 denied the allegations and according to outside source statements, there were no witnesses to corroborate either of the incidents. During a visit at the facility conducted on September 15, 2022, four (4) of five (5) residents in care were observed to be alert, dressed appropriately with no visible signs of neglect or physical abuse. Interviews with residents, staff and outside sources consistently indicated that they had never witnessed any staff member physically abusing any of the residents. Review of resident and facility records disclosed no reported incidents of injuries or abuse concerns during the time period of this complaint. There was insufficient evidence to support the allegations that staff hit or otherwise abused residents. It was also alleged that staff did not provide the dietary meal quantity to meet residents' needs. During the visit conducted on September 15, 2022, three (3) of the four (4) residents in care communicated what they ate for breakfast and lunch the day of the visit and the day prior to the visit. The meals provided to the residents were consistent with what the caregivers indicated they had served and with the sample menu posted at the facility. The residents in care looked healthy and well-nourished. During interviews, the residents consistently stated they got three meals a day plus snacks twice a day. In addition, the residents consistently stated they had never been denied food and they had access to food and snacks during the day. The refrigerators (2) and the pantry were observed to have supplies of nonperishable foods for one week and perishable foods for two days as required per Title 22 regulations. Interviews with outside sources voiced no concerns regarding the quantity of food being provided to the residents in care. Outside sources also indicated that the residents had not complained about being hungry. Interviews with staff indicated that they purchased groceries once or twice a week and more often as needed. Due to a lack of evidence, all three allegations are deemed to be unsubstantiated. A finding that is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence that the alleged violations occurred. An exit interview was conducted with Administrator, Vida Dacanay to whom a copy of this report, LIC 811 and Licensee Appeal Rights (9058 01/16) were provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Mar 20, 2023 · control 08-AS-20220909160015

Type of visit: Case Management - Other

Licensing Program Analyst (LPA), Marisela Garcia-Centeno, conducted a case management visit to to provide guidance on observations made during a complaint visit. LPA was granted entry into the facility by Caregiver, Alma Jaramillo. During the LPA discussed medication management procedures with facility staff. Topics discussed were record keeping, storage of medication, reporting requirements, per Title 22 regulations. An exit interview was conducted with Administrator, Dacanay, to whom a copy of the report and Licensee/Appeal Rights (LIC 9058 01/16) were provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Mar 20, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst, Amy Domingo, conducted an unannounced Required 1 - Year Visit. The facility file was reviewed prior to the visit. LPA met with Priscilla Dacanay and we discussed the purpose of the visit. All staff present have a current criminal record clearance. LPA conducted a tour of the facility, both inside and outside and observed the residents in care. In accordance with the Department’s Infection Control, LPA provided technical assistance, evaluated, and observed the facility's implementation of their mitigation plan to include disinfection, testing surveillance, and screening protocols as well as the use of personal protective equipment. No deficiencies were cited or observed on this date. An exit interview was conducted with Administrator Priscilla Dacanay and a copy of the signed report was provided in addition to a copy of their appeal rights (LIC9058 01/16). The Licensee will submit an updated LIC308, LIC500 and LIC610E, to CCLD within 14 days.the state’s words, verbatim · CDSS document, Jul 14, 2022

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced case management visit. LPA identified herself and stated the purpose of the visit to Caregiver, Carmelita Laxamana. The facility self-reported an incident regarding Resident 1 (R1) to Community Care Licensing on 12/20/21. The facility reported that on 12/19/21, R1 left the facility (AWOL) unattended and has not returned to the facility. Facility staff filed a missing persons report. On today’s date, LPA toured the facility and conducted a health and safety check. LPA briefly spoke with staff present at the facility and requested copies of R1 and facility records. No health or safety risks were observed and no deficiencies were cited at this time. An exit interview was conducted with Caregiver Carmelita Laxamana, a copy of this report and the LIC9058 Licensee/Appeal Rights were provided via E-mai to Administrator, Vida Dacanay. An electronic read receipt verifies receipt of these documents.the state’s words, verbatim · CDSS document, Dec 20, 2021