Facility Evaluation Report

In conjunction with complaint investigation, Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted a case management visit to address the deficiencies unrelated to the complaint.

Prior to this visit during Complaint Investigation on 12/12/25, LPA Alvizar-Ettima reviewed resident R1’s physician report and noted that it was not signed by resident and resident’s physician. The Administrator was advised that the licensee shall obtain a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year. The complete document shall be part of the resident's record. At the time of this visit Administrator indicated that it was the only physician report that they had in R1’s record file.

During this licensing visit, LPA Alvizar-Ettima discovered that staff#1, (S1) Luis Ernesto Mendez DOB: 08/07/1989 have been present without a Criminal Background Clearance and not Association to this facility. S1 has been working at facility since 11/10/25 providing care to the residents. LPA requested S1’s Identification Card and S1 stated that they did not have it. Later, S1 text Administrator a picture of their Republica De El Salvador identification card. LPA Alvizar-Ettima was informed that S1 has been transferred from La Casita Residential. LPA reviewed Licensing database and Criminal Background System and S1’s names did not appeared on Azalea House and Las Casita Residential facility records. S1 immediately left the facility. Administrator was advised that S1 cannot return until they have approved Criminal Background Clearance and Association to this facility.

During today’s physical plan tour LPA, Alvizar-Ettima observed that the first bedroom where resident #2-#3 (R2-R3) reside was being cosmetically repainted. No health and safety concerns were identified. A technical violation was provided regarding Department notification requirements for future physical plant modifications. The Administrator acknowledged understanding.

Under Title 22, Division 6. Chapter 8, following Citations and civil penalty and technical violation were issued and recorded on LIC809D. Exit interview was conducted, appeal rights provided and a copy of report was issued.