Facility Evaluation Report

On 11/18/2022 at 1:40PM, Licensing Program Analysts (LPAs) G. Luk and K. Nguyen arrived unannounced to conduct a POC (proof of correction) inspection. LPAs met with caregiver, Lester Calma informed him the reason for the visit.

The following deficiency was cleared by visit :

- 87205(a); As of 11/1/2022, RO (Regional Office) cease request for audit documents.

- 87156(a); LPAs observed licensee paid facility fees on 11/1/2022.

Civil penalties of $1200 is assessed for the period of 10/21/2022 to 11/1/2022 for failure to correct for deficiency 87205(a). Civil penalties of $1200 is assessed for the period of 10/21/2022 to 11/1/2022 for failure to correct deficiency 87156(a). Total civil penalties in the amount of $2400 is being assessed today.

Exit interview conducted. A copy of this report, civil penalties, and appeal rights provided.