Follow-up·April 9, 2026

Licensing Program Analyst (LPA) Hiratsuka, conducted this unannounced visit in response to not passing the facility on 04/01/2026, during the unannounced prelicensing visit because this facility is undergoing a change of ownership. A deficiency was issued against the current licensee of the facility. During the visit on 04/01/2026, LPA learned a resident did not receive a medication for almost a month because the medication was ordered on the day of the last dose, it arrived at the facility about fifteen days later, but was put with the overstock medications instead of being logged in correctly and the missed medication was brought up by the resident on 04/01/2026. The medication was restarted on 04/02/2026. LPA received a written plan of correction via email later on 04/01/2026, stating the staff will be retrained on 04/07/2026, and the medication program system will be checked weekly by a member of the facility administration team. LPA also received a copy of what the staff were trained on and a signed staff attendance sheet on 04/07/2026. The issue has been resolved. The facility now meets regulations. LPA is going to submit this report to the application specialist.