Facility Evaluation Report

On this day, 8/06/24, while at the facility investigating a complaint (Complaint Control # 15-AS-20240731080957), Licensing Program Analyst (LPA) Delmundo observed the following:

1. Staff (S1) is not fingerprinted and cleared.

2. Portable bed in resident's room and foldable bed in the closet in this resident's room. LPA verified, and according to the administrator, the beds are that of the staff. LPA also observed staff's personal stuff in the same room.

Deficiencies are cited from Title 22 California Code of Regulation, and listed on 809Ds. Civil penalties were assessed on this same day for the following:

1. Deficiency section 87355(e)(1) - $200.00 and will continue for $100.00/day until corrected.

2. Deficiency section 87307(a) - $250.00 for repeat violation within 12-month period.

Failure to submit proof of corrections may result in additional civil penalties.

Deficiencies, plan and proof of corrections, and civil penalties were discussed with the administrator.

Exit interview conducted. Appeal Rights, LIC421IM and LIC421FC Civil Penalty Assessments, LIC9098 Proof of Correction form and copy of this report provided.