Facility Evaluation Report

While at the facility investigating a complaint (Complaint Control # 15-AS-20240503132850) and upon observation and interview of staff and administrator's family member, Licensing Program Analyst (LPA) Delmundo learned the following:

1. Staff (S1 and S2) who works as reliever are fingerprint cleared but not associated to this facility. LPA interviewed administrator who stated she has not yet worked on the association of these 2 staff.

2. Administrator's family members (FM1 and FM2) who been staying in the facility are not fingerprinted. FM1 stated she comes and stay at the facility regularly. FM2 stated she's been staying here for about 2 months now.

3. FM1 stated she use the common area to sleep. LPA interviewed administrator who confirmed FM1 sleeps in the common area.

Deficiencies are cited from Title 22 California Code of Regulations, and listed on 809Ds. A $500 civil penalty for each, FM1 and FM2, is assessed and will continue for $100.00/day until corrected . Failure to submit proof of corrections by plan of correction due dates for the other 2 citations and any repeat violation within 12 month period may also result in civil penalties.

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

Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form, LIC421BC, and copy of this report provided.