Facility Evaluation Report

Licensing Program Analysts (LPAs) Reyes and Luis Deleon generated this Case Management - Deficiencies report pertaining to record review of the Staff Roster LIC 500. The purpose of the report was explained to Mirna Cuevas Caregiver and with Vanessa Ricchiazzi over the telephone.

LPAs observed upon record review of the staff roster LIC 500 and the LIS Facility Personnel Report Summary that staff #1 (S1 -S7) was not associated to facility.

Per California Code of Regulations, Title 22, and California Health and Safety Code, the deficiencies observed during the visit are documented on the 809D. Exit interview held and a copy of the report along with appeal rights were provided.

Immediate Civil Penalty in the amount of $3500 was assessed during today's visit.