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.

During Complaint Investigation, LPA Alvizar-Ettima discovered the following staff (S1) have been present without a Criminal Background Clearance and Association to this facility. Administrator indicated that S1 is her husband, visiting from Oregon and assisted Staff (S3) with the care of resident (R3) this morning (3/2/26). LPA request/received staff S1 Oregon Driver License. Administrator indicated that S1 was not associated to the facility. LPA verified using Guardian Background System Check, staff S1 names did not appeared on facility roster.

S1- Tito Basubas Peregrino DOB: 01/01/1971

S1 immediately left the facility. Administrator was advice that S1 cannot return until Criminal Background Clearance and Associated to this facility.

A citation and civil penalty were issued. Copy of this report was provide to Administrator.