Facility Evaluation Report

While at the facility conducting investigation of a complaint (Control # 15-AS-20250711090435) and upon meeting staff (S1) and review of names of employees fingerprinted and associated to the facility and conducting interviews, Licensing Program Analyst (LPA) Delmundo learned that a staff (S1) who has been working at the facility is not cleared and associated. This was discussed with Mary 'Rose' Malekamu Mataele, administrator (ADM). LPA asked for S1's file, and ADM stated S1 has no file. ADM only has a copy of correspondence from the Department's Care Provider Management Bureau dated March 7, 2025 indicating S1's case closure which is stored in ADM's cell phone.

Deficiencies are cited from Title 22 California Code of Regulations and listed on 809Ds. A $3,000.00 civil penalty is assessed for section 87355(e)(2) and $250.00 for section 87412(a) for repeat violations within 12 month period.

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

Exit interview conducted. Appeal Rights, LIC421FC and LIC421BG Civil Penalty Assessments, LIC9098 Proof of Correction form and copy of this report provided.