Facility Evaluation Report

On 6/6/2022 at 1:45PM Licensing Program Analysts (LPAs) L. Hall and L. Fici arrived unannounced to conduct a Case Management. LPA met with Menchie Matalang, Caregiver and explained the reason for the visit. LPA. L. Hall spoke with Imelda De Leon, Administrator and approval was given for Caregiver to sign documents.

While LPA L. Hall was conducting a complaint investigation 15-AS-20200508131152 on 5/5/2022 during record review LPA observed C1’s file was missing documents. LPA requested IPP (Individual Program Plan), ISP (Individual Service Plan), and behavioral assessment from Administrator. Administrator stated documents have been moved to storage off the premises of the facility.

The deficiency was observed (see LIC809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiency may result in civil penalties.

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