Facility Evaluation Report

Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an unannounced Plan Of Correction (POC) visit to follow up on the deficiency issued during the 4/28/22 case management visit. Upon arriving at the facility, LPA met with Staff / Reinalyn Martin and was later joined by the Administrator / Silvia Castro who assisted with the visit. The purpose of this visit was explained.

Personnel Requirements - General. Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall: Request a transfer of a criminal record clearance as specified in Section 87355(c). This requirement is not met as evidenced by:

During a complaint investigation conducted on 4/28/22, LPA discovered that individuals: Reinalyn Martin and Reginald Zaragosa have been working at the facility prior to requesting a transfer of a criminal record clearance.

The Plan of Correction (POC) for this deficiency stated that the Administrator will ensure individuals: Reinalyn Martin and Reginald Zaragosa are associated to St Matthews Home for the Elderly and provide proof to CCL by the POC due date of 4/29/22.

The Administrator failed to submit the POC to CCL by the POC due date of 4/29/22, therefore Civil Penalties are being issued for period 4/30/22 - 5/6/22. Total of 7 days, at $100.00 per day. The amount noted on Civil Penalty (LIC 421FC) is $700. Civil penalties will continue to accrue until the POC is submitted to CCL.

A deficiency is cited per California code of Regulations, Title 22, Division 6

LPA explained the citation, civil penalty assessment, and appeal rights.

Exit interview was conducted and a copy of the report and appeal rights were provided.