Facility Evaluation Report

Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced Case Management Visit-Deficiencies on 10/24/2025. LPA was greeted by Caregiver- Shirely Espinoza and explained the purpose of the visit.

On 10/24/2025, LPA Ramirez was conducting a staff records review, and it revealed that staff#1 (S1) and staff#2 (S2) did not complete a criminal clearance transfer prior to working at the facility. Interviews with S1 and S2 revealed they began their employment at the facility 2 weeks ago. Per title 22, Division 6, Chapter 8- Criminal Record Clearance 87355(e)(1)(3): (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Submit a valid mailing address at which the individual shall receive communications from the Department. (3) Request a transfer of a criminal record clearance as specified in Section 87355(c). Based upon records reviewed and interviews conducted, LPA Ramirez will issue one (1) Type A deficiency and one (1) civil penalty in the amount of $1000.00.

During tour of physical plant, LPA Ramirez observed refrigerated medication for Resident#1 (R1) on the side door of the kitchen refrigerator which was observed to be unlocked. Per title 22, Division 8, Chapter 8- Incidental Medical and Dental Care 87465(h)(2): (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. Based upon observation, LPA Ramirez will issue one (1) Type A deficiency.

Two (2) deficiencies were cited for this visit, and one (1) civil penalty was issued. Exit interview was conducted via telephone with Administrator Joel Villalva. A copy of this report, 809-D, LIC 421BG, and appeals rights were provided.