Facility Evaluation Report

LPAs K. Nguyen and A. Gomez arrived unannounced to conduct a case management regards to LIC 500. LPA was not able to reach the Administrator. LPAs spoke with Zella Cristobal and explained the purpose of the visit. Zella stating, she was a visitor who came to visit her brother, and when asked if there’s any staff in the facility she stated “NO” only her. Zella was listed as a volunteer on the LIC 500. Later Delze Cristobal arrived. LPA spoke with Administrator, Ana Breen. arrived at 10:35am.

LPAs requesting document to be submit to CCLD by 2/1/24:

LPAs toured the facility/ Observations at 10:15am:

- Medication was left unlocked inside the First Aid cabinet.

- Knife left out on the kitchen counter on the cutting mat. Knife left out by the sink. Dishwasher was left open knife was observed to be unlocked.

- Chemical was left unlocked in the bathroom cabinet and laundry mat.

LPAs observed a deficiency violation which have been cited (see LIC 809d) on 10/05/23. Immediate $500x3 and repeated violation $250 is assess today. Deficiencies, Plan of Corrections, Civil Penalties, Appeal Rights discussed with Ana Breen.

A copy of civil penalty is issue and appeal right provided to Administrator.