Facility Evaluation Report

Licensing Program Analyst (LPA) Luis De Leon conducted an unannounced Case Management visit for a health and safety check. LPA met with Caregiver Juan Lopez and the purpose of the visit was discussed. Mr. Lopez contacted Administrator via telephone to inform of today’s visit. Licensee arrived some time after to assist with visit.

During today’s visit, LPA Luis De Leon requested client and staff records for review. Staff stated that staff records were kept secured by administrator. LPA requested the following records: Client roster, Personnel Report (LIC-500), Personnel Record (LIC-501), Health Screening (LIC-503), and In-service training, The licensee arrived sometime after and contacted administrator for location of staff records. Licensee informed LPA De Leon that requested records were not available and licensee was not able to find staff records in the facility. Per Title 22 regulations 80066 (c) All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours… Base upon this observation and record review, LPA De Leon will issue a deficiency.

Exit interview was conducted. A copy of this report, 809-D and appeals rights was provided to licensee Peggie De Leon.