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Facility Evaluation Report

Elim Assisted Living, Concord06/06/2025Licence 075600223

Capacity6
Census6
Date signed06/06/2025 05:15:10 PM
Name of licensing program analystAlicia Delmundo
Name of licensing program managerBennett Fong
The inspector’s account

While conducting investigation of a complaint (Control # 15-AS-20220202085410), and upon review of records, staff roster, and Community Care Licensing's Guardian Portal for list of individuals with fingerprinting and upon interviews, LPA learned that 3 staff (S1, S2, S3) who worked at this facility were not fingerprinted. LPA interviewed S1 who confirmed she worked at the facility from April 2020 to August 2021 and was not fingerprinted. LPA obtained copies of LIC501 Personnel Records for these 3 staff from licensee's son.

Deficiencies are cited from Title 22 California Code of Regulations and listed on 809D. A total of $1,500.00 civil penalty is assessed for section #87355(e)(2); $500.00 each for S1, S2 and S3.

Deficiencies were discussed with licensee.

Exit interview conducted. Appeal Rights, LIC421BC and copy of this report provided.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction